A condition affecting adolescents in which the femoral head slips at the growth plate, requiring urgent surgical treatment. Mr Balakumar is one of the few surgeons in Australia trained in the capital realignment technique.
(03) 9573 9659
Slipped upper femoral epiphysis (SUFE) is the most common hip disorder in adolescence and should be treated as an orthopaedic emergency. Delay in treatment increases the risk of serious and potentially irreversible complications. Mr Balakumar is one of the few surgeons in Australia trained in the capital realignment technique, which aims to restore near-normal anatomy of the femoral head at the time of the original surgery.
SUFE occurs when the growth plate (physis) of the femoral head is disrupted, causing the femoral head to slip backwards and downwards relative to the femoral neck. It is effectively a fracture through the ball and neck junction, but it behaves very differently from a standard fracture. It most commonly occurs during periods of rapid growth, when the growth plate is under increased mechanical stress.
The slip may develop gradually over weeks or months (chronic SUFE) or occur suddenly (acute SUFE). An unstable SUFE, where the patient is unable to bear weight, requires emergency surgery.
SUFE most commonly affects adolescents between the ages of 8 and 15. It is more common in males and is associated with obesity, rapid growth and hormonal factors. It affects both hips in up to 50 per cent of patients, which is why the opposite side is sometimes also fixed to prevent a second slip.
Patients with chronic SUFE typically present with hip or knee pain and a limp that has developed over several weeks or months. Knee pain as the presenting complaint is common and can lead to a delay in diagnosis if the hip is not also examined. On examination, the affected leg is often held in external rotation and internal rotation of the hip is restricted.
Acute SUFE presents with sudden, severe hip pain and an inability to bear weight. This is a surgical emergency.
The traditional treatment involves fixing the femoral head in its slipped position with a single cannulated screw to prevent further movement. This is effective at stabilising the growth plate but leaves the deformity in place. A significant residual deformity results in an abnormal femoral head and neck junction that causes femoroacetabular impingement over time, leading to early cartilage damage and arthritis. In some patients a corrective osteotomy is required at a later stage to address this.
Mr Balakumar is one of the few surgeons in Australia trained in the capital realignment technique. This more complex procedure restores near-normal anatomy of the femoral head while carefully preserving its blood supply. By correcting the deformity at the time of the original surgery, the long-term risk of impingement and early arthritis is significantly reduced.
This technique requires advanced fellowship training and is performed at a small number of specialised centres worldwide. Mr Balakumar trained in this technique during his fellowship at Harvard’s Children’s Hospital Boston and performs it regularly.
The principal risk of SUFE surgery is avascular necrosis (AVN), in which the blood supply to the femoral head is disrupted, causing the bone to die. AVN can result in severe early arthritis and is more common with unstable SUFE and with certain surgical techniques. Hip arthroscopy can also be helpful in facilitating the natural reshaping of the femoral head following treatment. Mr Balakumar discusses the specific risks of each approach in detail at the consultation.
(03) 9573 9659
Mr Balakumar is one of a small number of surgeons in Australia with formal training in both paediatric and adult hip surgery. His fellowship at Harvard’s Children’s Hospital in Boston, under some of the world’s leading specialists in hip preservation, gives him a depth of expertise that is difficult to find in a single practice.
His approach is the same whether the patient is 6 months or 65 years old – thorough assessment, honest options, and no pressure toward surgery until the clinical picture clearly supports it.
(03) 9573 9659
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