Sequential bilateral hip deformities

Diagnosis: Bilateral slipped capital femoral epiphysis

This patient’s radiographic findings (FIGURES 1A and 2A) confirmed that she had experienced sequential bilateral slipped capital femoral epiphysis. SCFE occurs when the femoral head is displaced through the weakened physis, usually medially. Most common in the adolescent years, it is likely caused by the alteration in the plane of the physis during the adolescent growth spurt, in addition to the increased forces of weight gain. Obesity has been shown to be a significant risk factor.¹ A small percentage of patients have an underlying endocrine disorder.^2,3

FIGURE 2
One hip fixed, trouble in the other

Differential Dx includes tumors, traumatic injuries

In adolescents who present with hip pain, the differential includes infectious etiologies (eg, septic arthritis, osteomyelitis), tumors, and traumatic injuries (eg, contusions, fractures, epiphyseal injuries). This patient’s characteristic presentation and physical exam raised my suspicion of SCFE. The classic radiographic findings confirmed my suspicion.

Treatment can’t wait
Untreated or delayed treatment of SCFE is associated with significant morbidity, including osteonecrosis, chondrolysis, and chronic pain and deformity. Among patients who experience an initial SCFE, an estimated 30% to 60% will experience a future contralateral slip.^4,5

The management of the contralateral hip is controversial. Several studies have explored which patient factors are most predictive of future contralateral slips, and which patients would benefit from prophylactic contralateral pinning. Younger age at presentation—<12 years for girls and <14 years for boys—has been shown to be the most predictive factor of future contralateral slips.⁶ Other factors, such as race, sex, and skeletal maturity, have not been statistically significant predictors of future slips.⁶ Older age, in contrast, has been associated with increased slip severity.⁷