What is the prevalence of slipped capital femoral epiphysis (SCFE) in the US?

Updated: Dec 03, 2018
  • Author: Kevin D Walter, MD, FAAP; Chief Editor: Craig C Young, MD  more...
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Answer

The overall incidence for SCFE in the United States is 10.8 cases per 100,000 children. [14] The incidence rate in boys (13.35 per 100,000) is higher than in girls (8.07 per 100,000). When compared with white children, black children have a higher incidence rate at 3.94 times, and Hispanic children have a 2.54 times higher incidence rate.

Rates of SCFE per 100,000 children are higher in the Northeast (17.15) and West (12.70) than in the Midwest (7.69) and South (8.12). [15] Evidence also points to a seasonal variation in SCFE occurrence. In areas north of 40º latitude, 57.4% of SCFEs occurred during the summer, whereas in areas south of 40º latitude, 57.3% of SCFEs occurred during the winter months. [14]  A study by Loder et al reported new seasonal variation findings in 10,350 cases of slipped capital femoral epiphysis. The study found a peak in August/September in both the Southern and Northern US with a second peak in March/April found only in the Southern US. Areas with more seasonal variability in temperature, humidity and sunlight were more likely to have greater variability. [16]  

SCFE mainly occurs between the ages of 10 and 16 years. [1, 14] A slight downward trend has occurred for average ages over several years, with some data finding the average age for boys at 12.7 years and girls at 11.2 years. This change could be due to the phenomenon of children maturing at a younger age. [17]

In general, about 20% of patients have bilateral involvement at the time of presentation. It is felt that an additional 20-40% will subsequently progress to bilateral slips. When the presentation is sequential, the second hip usually presents within 18 months of the first SCFE. [18, 19]

The risk of SCFE is increased in children who are obese, as well as in children with other medical issues such as hypothyroidism, low growth hormone level, pituitary tumors, craniopharyngioma, Down syndrome, renal osteodystrophy, and adiposogenital syndrome.

In a study by Benson et al, the investigators reexamined the incidence of SCFE in New Mexico (previous studies had reported almost a 5-fold lower incidence of SCFE in New Mexico compared with Connecticut). The discharge databases for the 11 major medical centers in New Mexico from 1995 to 2006 were analyzed by comparison with the 2000 New Mexico census data. The incidence data are reported as cases per 100,000 boys aged 10-17 years and girls aged 8-15 years, as per the earlier study data. [20]

The investigators found an incidence rate of SCFE in New Mexico for the study period was 5.99, which was a statistically significant change that was more than double the reported incidence in the 1960s (2.13). Obesity was noted as a patient factor that changed since 1971 (tripled), although the national incidence of SCFE appeared to have remained fairly constant at 10.8 per 100,000. Benson et al theorized that "increased obesity in children and improved access to pediatric orthopaedic evaluation may have contributed to a significant increase in reported incidence of SCFE in New Mexico." [20]


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