Slipped Upper Femoral Epiphysis (SUFE)

What is a slipped epiphysis?

Slipped Upper Femoral Epiphysis  is a condition that happens in late childhood/early adolescence where the epiphysis (the growth center) of the femoral head displaces or slips out of alignment from the rest of the femur.  As a result, there is a change in shape of the hip joint.

 

Why causes SUFE?

Often no underlying cause is found.  Some theories suggest that hormonal imbalance between the growth and sex hormones is involved. However, there has never been conclusive evidence to support this. Studies have shown that the epiphyseal plate is rapidly proliferating and vulnerable to shear stress during adolescence. The extra body weight during this phase of life tilts the balance, and causes the slip to occur. . Approximately 20% of children who develop SUFE will develop it in the other hip within 6 months. Children who develop SUFE at a very young age or who have an underlying disorder predisposing to the condition are much more likely to have both hips affected.

 

What is the initial treatment for SUFE?

The principle of initial treatment is to prevent continued progresson of the deformity. This involves an operation where a screw is placed across the weakened growth plate to stabilise the bone and prevent further slipping. This is best performed as soon as the diagnosis of SUFE is made.

 

What is the natural course of SUFE?

Changes in the shape of the hip joint means that the joint surfaces are predisposed to accumulate damage.  This results in early osteoarthritis. In addition, the hip joint may become stiff with reduced bending motion. SUFE is a leading cause of femoro-acetabular impingement (FAI).   In adults, the hip becomes painful when there has been enough damage in the joint. The first symptom is often mild groin discomfort. Once the joint becomes painful, gradual deterioration of the hip joint can reliably be predicted; however reducing activity levels may reduce the symptoms.

 

What is the treatment for adults with previous SUFE?

This will depend on the presenting symptoms, the shape of the hip joint and how much damage has occurred within the joint surfaces. Many patients can improve their symptoms without surgery, by changing activity levels and/or using medication.  Since the deformity within the hip is permanent, the occurrence of pain is likely to predict slow progression of the disease process. In patients with early damage to the hip joint, joint preserving procedures such as hip arthroscopy (key hole surgery) can improve symptoms. In some instances hip arthroscopy can also be used to correct a portion of the underlying hip joint deformity (procedure known as an arthroscopic osteoplasty). In younger adults with more significant deformity, open debridement may be recommended. Ultimately, hip joints with end stage arthritis secondary to SUFE are best treated with an artificial joint replacement. In these situations, both hip replacement and hip resurfacing are effective solutions.