Slipped Upper Femoral Epiphysis: What Is SUFE and Why Does It Need Urgent Attention?
A slipped upper femoral epiphysis (SUFE) happens when the ball at the top of the thigh bone shifts backward on the growth plate. It mainly affects teenagers during growth spurts. SUFE causes hip, groin or knee pain and a limp. It is classed as an orthopaedic emergency, because a delay in diagnosis raises the risk of serious complications.
Key points
- SUFE is a growth-plate injury in which the femoral head slips out of position.
- It typically occurs in the teenage years, often linked to rapid growth or higher body weight.
- Pain can appear in the hip, groin or knee, so knee pain alone should never rule SUFE out.
- Early diagnosis and urgent surgery to stabilise the hip give the best outcomes.
- Standing, weight-bearing imaging can reveal alignment problems that lying-down scans may miss.
SUFE (also called SCFE, slipped capital femoral epiphysis) is the most common hip disorder in teenagers. The growth plate at the top of the femur weakens, and the ball of the hip joint slips backward and downward. If it is not recognised quickly, the blood supply to the femoral head can be damaged. This leads to a condition called avascular necrosis, where the bone tissue begins to die.
The pain sometimes shows up only in the knee or thigh, not in the hip itself. Because of this, SUFE is one of the most commonly delayed diagnoses in teenage orthopaedics. Knowing the signs matters.
What are the symptoms of a slipped upper femoral epiphysis?
The most common symptoms are a limp, hip or groin pain, and sometimes pain felt only in the knee or thigh. The pain can be "referred" away from the hip. So teenagers are sometimes checked for a knee problem while the real problem at the hip is missed.
A limp that gets worse over weeks, or appears suddenly after a minor fall or twist.
Aching or stiffness in the hip or groin. Knee or thigh pain alone is a well-known "trap."
The affected leg often turns outward when walking or when the hip is bent. This is a key clinical sign.
Difficulty turning the hip inward, bending it fully, or sitting cross-legged.
Urgent advice: If your child has sudden, severe hip pain and cannot put weight on the leg, this may be an acute or unstable slip. Seek urgent medical help straight away from your doctor or the nearest emergency department. Do not wait for an outpatient scan.
What causes a slipped upper femoral epiphysis?
The growth plate weakens during rapid growth. Body weight and mechanical stress together then cause the femoral head to slip. The exact trigger is not always clear, but several factors increase the risk.
Growth spurts in the teenage years weaken the growth plate for a time.
Obesity is a recognised risk factor. It increases the mechanical load on the growth plate.
Some hormone (endocrine) conditions, such as hypothyroidism, can weaken the growth plate further.
SUFE most commonly appears between the ages of 10 and 16. It is more frequent in boys than girls. Importantly, there is a bilateral risk: after a slip on one side, there is a meaningful chance that the other hip is affected too. So both sides are usually monitored.
How is a slipped upper femoral epiphysis diagnosed?
SUFE is diagnosed with a clinical examination together with imaging. A doctor will check hip movement and look for the hallmark sign: the leg turning outward when the hip is bent. X-rays of both hips, including a specific lateral (side) view, confirm the slip.
Early and mild slips can be hard to see on a standard front-on X-ray alone. This is one reason a lateral view is so important. If the doctor strongly suspects SUFE but the X-rays look normal, an MRI may be used to detect a very early, "pre-slip" stage.
When MRI is the better tool: EOS and X-ray are excellent for showing bone position and alignment. For looking at the blood supply to the femoral head, cartilage damage or very early pre-slip changes, MRI is usually the better choice. The two types of imaging work best together.
Delayed diagnosis is a well-documented problem with SUFE. Studies show that the average time from first symptoms to diagnosis can be many weeks, especially when the pain is felt only in the knee. Any teenager with an unexplained limp, hip stiffness, or knee pain without a clear knee injury should have their hips checked.
How is SUFE treated?
SUFE is treated with surgery. The standard operation is urgent pinning (in-situ fixation). A screw is placed across the growth plate to stop the slip getting worse and to allow healing. The goal is to stabilise the hip before it moves out of place any further.
How urgent it is depends on how the slip is classified. An "unstable" slip, where the teenager cannot bear weight at all, is treated as an emergency. A "stable" slip, where they can still walk with pain, is still treated promptly, usually within days.
After surgery, the orthopaedic team monitors both hips over time. Because of the bilateral risk, the other hip may also be pinned to prevent a slip in some cases. Long-term follow-up watches for complications such as avascular necrosis or early wear of the joint.
ScanAlign does not provide treatment. It is a diagnostic imaging service. If SUFE is suspected, the priority is always the treating surgical team. Imaging can play a supporting role in follow-up, checking alignment and recovery over time.
How does standing imaging help after SUFE?
Standing, weight-bearing imaging captures the skeleton under real-life load. When you lie down for a normal X-ray, CT or MRI, gravity is removed and the muscles relax. This can hide alignment differences that only appear when standing.
After SUFE treatment, it helps to see how the hip sits in relation to the pelvis, spine and legs while standing. This gives a more complete picture. A slip on one side can cause the pelvis to tilt, the spine to compensate, and the other leg to carry load differently. These knock-on effects are part of the body's connected chain from feet to head, and they only show up under weight-bearing conditions.
EOS imaging uses about 90% less radiation than a standard X-ray, around ten times less. For young patients who may need repeated imaging over years of follow-up, keeping the radiation dose as low as possible is especially important.
At ScanAlign, low dose standing imaging, the EOS system captures a full-length view of the skeleton in one standing exposure. This lets clinicians see the whole alignment picture, not just the hip on its own. Learn more about children's imaging at ScanAlign.
If your child has been treated for SUFE and you want a clear picture of their whole-body alignment during recovery, we can help, including if you are planning to travel to London for the scan.
Book a free video consultationIs SUFE linked to other hip conditions?
SUFE is a separate condition from developmental dysplasia of the hip (DDH), in which the hip socket is too shallow. However, both conditions affect hip alignment during growth. Both can have long-term effects on how the joint works if not managed well. They are diagnosed and treated differently, but the idea of checking whole-body alignment applies to both.
Before your child starts treatment, or changes the treatment they are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
Frequently asked questions about SUFE
SUFE is a condition where the ball at the top of the thigh bone (femoral head) slips backward on the growth plate. It typically affects teenagers during growth spurts and needs urgent surgery to prevent further damage.
They are the same condition. SUFE stands for slipped upper femoral epiphysis, the term commonly used in the UK. SCFE stands for slipped capital femoral epiphysis, the term more widely used in North America. Both describe the same growth-plate slip at the top of the thigh bone.
The hip and knee share some of the same nerve supply. When the hip joint is irritated, pain signals can be "referred" along those nerves and felt in the knee or thigh. This is why any teenager with unexplained knee pain and a limp should also have their hips examined.
Yes. There is a recognised bilateral risk. After a slip on one side, the other hip is monitored closely and may be pinned to prevent a slip. Both hips are usually X-rayed at diagnosis and followed up over time.
Without prompt treatment, the slip can get worse and the blood supply to the femoral head may be disrupted, leading to avascular necrosis. This can cause lasting damage to the joint and may eventually need more complex surgery.
EOS uses about 90% less radiation than a standard X-ray, around ten times less. This makes it a particularly low-dose option for younger patients who may need repeated imaging during follow-up.
No. ScanAlign accepts self-referrals. You can book directly by starting with a free video consultation, where a specialist radiographer reviews your situation before any scan takes place.
The price for patients travelling from abroad is confirmed during the free video consultation.
A standard X-ray usually images one area at a time, often while lying down. EOS captures a full-length standing image from head to feet in a single pass. It shows how the whole skeleton is aligned under natural weight-bearing conditions. It also uses significantly less radiation.
ScanAlign is a diagnostic imaging clinic, not a treatment centre. If SUFE is suspected or has been treated, ScanAlign can provide standing alignment imaging to support ongoing care. Diagnosis and surgery are carried out by the treating orthopaedic team.
Want a clearer picture of hip alignment?
A free video consultation with a specialist radiographer is the first step. No referral needed.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Loder RT, Skopelja EN. The epidemiology and demographics of slipped capital femoral epiphysis. ISRN Orthopedics. 2011;2011:486512.
- NHS. Slipped upper femoral epiphysis (SUFE). NHS Conditions. Available at: nhs.uk.
- British Orthopaedic Association. BOAST Guidelines: The Management of Children with Acute and Acutely Displaced SUFE. BOA/BSCOS, 2018.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.