Key points about SUFE
- SUFE is a condition affecting the hip joint in tamariki and rangatahi (young people)
- it can cause pain in the hip, groin, thigh or knee
- early diagnosis and treatment are important
- surgery is always needed to treat SUFE
- if your child suddenly develops all the symptoms of SUFE, do not let them walk on the leg and take them to a health professional urgently
What is SUFE?
Slipped upper femoral epiphysis (SUFE) is a condition involving the hip joint. It is also known as slipped capital femoral epiphysis (SCFE).
SUFE happens when the growth plate (physis) at the top of the thigh bone (femur) is weak. This causes the top of the thigh bone (femoral head/epiphysis) to slip out of its normal position.
A bit about the hip
The hip joint includes the:
- thigh bone (femur)
- hip bone (pelvis)
- muscles, ligaments and tendons around the hip joint act like strong ropes to hold the bones together
The hip joint works like a ball and socket joint. The top of the thigh bone is shaped like a ball which is called the femoral head. The femoral head sits inside a cup-shaped socket in the pelvis.
Who gets SUFE?
SUFE often occurs in tamariki and rangatahi during periods of rapid growth such as puberty. It is more common in boys. SUFE may be more common in tamariki who have a family member who has had SUFE.
Causes of SUFE
The exact cause of SUFE is not known. It may be linked to the body’s growth changes during puberty. The growth plate in the hip may become weaker due to changes in hormones or body weight, making it more likely to slip.
SUFE doesn’t usually happen from an injury.
Symptoms of SUFE
Symptoms of SUFE in tamariki and rangatahi can develop suddenly or slowly over months. SUFE usually only happens in one hip but it can happen in both hips.
Symptoms include:
- pain in the hip, groin, thigh or knee
- a limp or difficulty walking
- trouble moving the hip normally
- a slight shortening of the affected leg
- turning out of the affected foot
For some tamariki, their only symptom is knee pain, even though the problem is in the hip.
When to get medical help for your child
If your child has ongoing pain around the hip or knee, take them to a health professional. The health professional will ask you questions and examine your child to work out the cause of their pain.
If your child develops all the symptoms of SUFE suddenly, do not let them walk on the leg. Take them to a health professional urgently.
Early diagnosis of SUFE is important. Catching it early can help stop it from getting worse.
Diagnosing SUFE
To diagnose SUFE a health professional will examine your child’s leg and watch how they walk. If they think your child may have SUFE, they will arrange an x-ray of your child’s hip. Some tamariki may also need an MRI scan to look at the hip joint.
Managing SUFE
All tamariki and rangatahi with SUFE need surgery. This surgery is done by an orthopaedic surgeon (a doctor who specialises in bones).
Before the surgery tamariki and rangatahi with SUFE need to avoid standing or putting weight through their leg. This means they need bed rest or to use a wheelchair to get around.
There are different types of surgery for SUFE depending on how severe the slip is. Most surgeries involve screws being put into the head of the thigh bone to keep it stable. After the surgery your child will have an x-ray to check the screws are in the right place.
Some tamariki and rangatahi may need surgery on their other hip as well. This is to prevent the same thing happening on the other side in the future.
Your child will have a general anaesthetic and be fast asleep for the whole surgery.
After treatment for SUFE
After your child has their surgery, they will need to stay overnight in hospital. They may need to stay for a couple of nights until they are comfortable.
Your child will likely need to avoid putting weight on the leg that was operated on after surgery. They will need to be able to use crutches or a wheelchair safely before they can go home from hospital. The hospital staff will teach your child how to get around with crutches or a wheelchair before you go home.
Managing at home after surgery
Wound care
After surgery, your child will have a wound on the leg. The wound will likely be covered by a waterproof dressing. Your health professional will give you instructions on how to care for the dressing when you get home.
If you are worried that your child’s wound could be infected see a health professional urgently.
Signs of a wound infection include:
- redness and heat around the wound
- increasing pain around the wound
- fever
- swelling around the wound
- an odd smell at the wound
- fluid oozing from the wound
Pain relief
Before your child leaves the hospital, health professionals will make a plan with you for managing your child’s pain.
Most tamariki and rangatahi will need pain medicine, such as Paracetamol, for the first few days after surgery. If Paracetamol is not helping, talk to the health professionals about how to manage your child's pain - they may prescribe other pain medicine for your child.
For any pain medicine, you must follow the dosage instructions on the bottle or packet. It is dangerous to give more than the recommended dose.
Moving around
After surgery, your child won’t be able to stand or walk on the affected side for around 6 weeks. They will need to use crutches or a wheelchair to get around.
A health professional will let you know when your child can return to normal activities such as school. They will also guide you on when it’s OK for your child to go back to sports.
Follow-up for SUFE
Your child will need to go back to the hospital 1 to 2 weeks after surgery to get their wound checked. They will also need to go back around 6 weeks after surgery for x-rays. The orthopaedic team will let you know when your child will need further follow-up.
The screws in your child’s hip may be removed once the growth plate has finished healing. Your child won’t be able to play any contact sports until after the growth plate has finished healing.
Long-term impact of SUFE
Most tamariki and rangatahi with SUFE who get prompt treatment get completely better with no long-term problems.
A small number of tamariki and rangatahi may develop some complications in the future such as hip stiffness, pain or early-onset arthritis. It is important for your child to have regular follow-up with health professionals for monitoring and to address any concerns you may have.
