What is slipped upper femoral epiphysis (SUFE)?

Slipped upper femoral epiphysis (SUFE) is a condition primarily affecting adolescents that can lead to pain, mobility issues, and potentially serious complications if not treated promptly.

Here, Mr Kyle James, renowned consultant paediatric orthopaedic surgeon, offers an expert insight into SUFE.

What is SUFE?

SUFE is a condition where the ball at the upper end of the thigh bone slips backward and downward at the growth plate. This part of the bone is called the femoral head, and its displacement disrupts normal hip joint function. SUFE typically occurs during periods of rapid growth, such as adolescence, usually between the ages of 10 and 16. It typically affects boys more frequently than girls.

The primary symptom of SUFE is hip or knee pain, which may be intermittent at first but can worsen with activity. Other signs include:

• a noticeable limp due to pain or discomfort
• difficulty in moving the hip joint
• instability or a sensation of the hip joint “giving way”

These symptoms may develop gradually or suddenly and should prompt a visit to a specialist for evaluation.

What causes SUFE?

The exact cause of SUFE isn’t always known, but factors such as rapid growth, obesity, hormonal changes, and genetics may contribute to its development. It can also be associated with conditions like hypothyroidism and kidney disease.

How is SUFE assessed and diagnosed?

Prompt diagnosis of SUFE is crucial for effective treatment. A specialist, such as a paediatric orthopaedic surgeon, typically begins with a complete medical history and physical examination. Imaging tests are then used to confirm the diagnosis and assess the extent of the slip. These may include:

• X-rays: X-rays provide detailed images of the hip joint to identify the slip and any associated changes.
• MRI scans: MRI scans offer more detailed views of soft tissues and helps evaluate blood flow to the femoral head.

In some cases, a CT scan may be recommended to further evaluate the hip joint and surrounding structures.

What treatment options are available for SUFE? Are there non-surgical approaches, or is surgery typically necessary?

Treatment for SUFE focuses on stabilising the femoral head, alleviating pain, and preventing additional slipping. The treatment approach varies based on the severity of the condition and may involve non-surgical or surgical interventions.

Conservative treatment

In less severe cases of SUFE, non-surgical treatments may be considered:

• Activity modification: Limiting weight-bearing activities to reduce stress on the hip joint.
• Physical therapy: Physiotherapy exercises to maintain range of motion and strengthen the hip muscles.

Surgical treatment

For more severe cases of SUFE, surgery is often necessary to stabilise the femoral head. Common surgical procedures include:

• In situ fixation: Placement of screws or pins through the growth plate to hold the femoral head in place.
• Osteotomy: Osteotomy involves surgical repositioning of the femoral head to restore normal alignment.
• Hip replacement: In rare cases of severe damage, a hip replacement may be required, although this is uncommon.

The choice of surgical technique will depend on the specific characteristics of the slip and the individual patient's needs.

What kind of follow-up care will my child need after treatment for SUFE?

Following treatment for SUFE, ongoing care and monitoring are essential to ensure optimal recovery and reduce the risk of complications. The specialist will provide specific guidelines based on the treatment received, but general follow-up care may include:

• Physical therapy: Rehabilitation exercises to restore strength and mobility.
• Regular check-ups: Periodic X-rays or MRI scans to evaluate the hip joint over time.
• Activity restrictions: Guidelines on activities and sports participation to prevent re-injury.

It's important to adhere to the specialist’s recommendations and promptly report any new symptoms or concerns during follow-up visits. With early diagnosis and appropriate treatment, many patients with SUFE can recover well.

To schedule an appointment with Mr Kyle James, head on over to his Top Doctors profile today.