Delayed-onset of slipped capital femoral epiphysis

Slipped capital femoral epiphysis in adults is uncommon. The purpose of this study was to report our own four cases (six hips) of slipped capital femoral epiphysis (SCFE) in adulthood and to review the cases reported in the literature. The authors attempted to investigate the various causative underlying disorders and clinical characteristics, treatment, outcome, and complications.

We searched for all 22 reported cases of SCFE in adults age 18 years and older via MEDLINE and Google Scholar from 1963 to 2012 without any exception. In doing so, we documented our own four cases, along with seven additional reports that we found in the literature but were not reported by Hu et al. in 2011.

All of 22 cases involved causative pathology: panhypopituitary disorders in 11, hypothyroidism in five, Kallmann syndrome in three, postradiation hypoestrogenism in one, hypogonadotropic hypogonadism as sequel of meningitis in one, and Klinefelter syndrome in one. Eight cases (36 %) involved both hips. The most common treatment modality was internal fixation combined with hormonal replacement therapy. Nineteen hips (63 %) healed well without any complications after fixation of the slipped epiphysis. Avascular necrosis of the femoral head developed in one hip after in situ pin fixation.

Awareness of the variety of conditions under which SCFE can occur is an important factor in early diagnosis, especially in slippage at atypical ages. In the adults with SCFE, it is very important to look for bilateral involvement as this occurs in 36 % of cases.