Childhood Hip Disorders in Adults: Perthes and SCFE
Legg-Calve-Perthes disease and slipped capital femoral epiphysis (SCFE) are childhood hip conditions that leave residual deformity of the femoral head. In adulthood, that deformity causes secondary impingement, cartilage damage, and early-onset hip arthritis, typically in the 30s, 40s, and 50s. Mr Shakir Hussain, Consultant Orthopaedic Surgeon at the Royal Orthopaedic Hospital Birmingham, treats post-Perthes and post-SCFE hip arthritis with hip replacement and, in selected younger men, hip resurfacing.
What are Perthes disease and SCFE?
Legg-Calve-Perthes disease is an idiopathic interruption of blood supply to the femoral head in children aged 4 to 8 years, causing the head to soften, deform, and then heal in an abnormal shape. Slipped capital femoral epiphysis (SCFE) is an adolescent condition (typically age 10 to 16) in which the femoral head slips backwards and downwards on its growth plate. Both leave residual hip deformity that frequently causes early-onset arthritis in adulthood.
Although these are two different childhood conditions with different mechanisms, they share a critical adult consequence: residual deformity of the femoral head, which produces secondary femoroacetabular impingement, premature cartilage damage, and early-onset hip arthritis. Many patients only discover their childhood diagnosis when adult hip symptoms prompt their first X-rays.
Legg-Calve-Perthes disease (LCPD):
- Idiopathic juvenile avascular necrosis of the femoral head
- Typical onset age 4 to 8 years
- Boys affected approximately 4 times more often than girls
- 10 to 15 per cent bilateral
- The femoral head softens during the avascular phase, then deforms and heals over years
- Severity is graded after healing using the Stulberg classification (I to V); higher grades predict worse adult outcomes
- 40 to 80 per cent of patients develop adult hip osteoarthritis by age 50, with risk strongly tied to Stulberg grade
Slipped capital femoral epiphysis (SCFE):
- Adolescent hip condition where the femoral head slips on its growth plate
- Mean age at presentation 12 in girls, 13.5 in boys
- Boys 1.5 to 1.7 times more often than girls
- 30 to 60 per cent are bilateral (contralateral slip is common)
- Strongly associated with obesity; rising incidence parallels childhood obesity rates
- Severity graded by Loder classification (stable vs unstable) and by the percentage slip
- 30 to 90 per cent develop adult hip osteoarthritis at 30 to 40-year follow-up, depending on slip severity
What does post-Perthes or post-SCFE hip arthritis feel like?
Adult patients with childhood Perthes or SCFE typically present with insidious groin pain in their 30s or 40s, a noticeable limp on the affected side, leg length discrepancy from childhood, restricted internal rotation of the hip, and mechanical clicking from secondary labral tears. Many patients have known about their childhood hip disease for decades but are surprised by the early adult onset of arthritis.
The presentation can resemble adult femoroacetabular impingement because that is mechanically what is happening: the mis-shaped femoral head jams against the acetabular rim during normal activity. The clue is the much earlier age of arthritis onset than would be expected in primary osteoarthritis.
Groin pain in early adulthood
Activity-related groin or thigh pain starting in the 20s, 30s, or 40s. The pain is mechanical and worse with bending, sitting, and pivoting.
Long-standing limp
Many patients have walked with a slight limp since childhood and are used to it. A worsening of the limp in adulthood is often the first sign that the hip is failing.
Leg length discrepancy
Common after Perthes (the affected femoral head is often shorter) and after severe SCFE. Patients describe needing a heel lift or noticing the affected side is "lower" when looking in a mirror.
Reduced internal rotation
The classic physical sign in both post-Perthes and post-SCFE hips. The affected leg cannot be rotated inward at the hip as far as the unaffected side because of the deformed femoral head.
Mechanical clicking and catching
The deformed femoral head causes secondary labral tears in many post-Perthes and post-SCFE hips, producing the same clicking and catching seen in primary FAI.
Pain on pivoting and sport
Cutting, twisting, and pivoting movements (football, cycling, dance, hiking on uneven ground) provoke impingement against the rim of the socket and trigger pain.
Why do childhood hip disorders cause adult arthritis?
Both Perthes disease and SCFE leave the femoral head mis-shaped after healing. The deformed head no longer fits perfectly into the acetabular socket, so during normal hip movement the rim of the socket catches against the femoral neck (secondary femoroacetabular impingement). Repeated impingement over years tears the labrum, damages cartilage, and produces early-onset osteoarthritis, often decades before primary osteoarthritis would appear.
The most important predictors of adult arthritis after childhood hip disease are:
- Stulberg classification (Perthes). After Perthes healing, the femoral head is graded I (spherical, normal size) through V (severely flattened and aspherical). Stulberg III, IV, and V are strongly associated with adult osteoarthritis; Stulberg I and II do well long-term.
- Slip severity (SCFE). The percentage slip and the Loder classification (stable versus unstable) at original presentation determine the residual deformity. Severe and unstable slips give the worst long-term outcomes.
- Bilateral disease. Bilateral Perthes (10 to 15 per cent) and bilateral SCFE (30 to 60 per cent) leave both hips at risk.
- Coxa magna and short neck. An enlarged, mushroom-shaped femoral head with a short, broad neck is the classic post-Perthes deformity. It produces marked secondary impingement.
- Residual femoral head retroversion (SCFE). The femoral head sits behind the femoral neck after a posterior slip, blocking internal rotation and producing impingement.
- Cartilage damage at the time of childhood disease. Both conditions can damage cartilage during the active phase of disease, leaving less reserve for adult life.
- Avascular necrosis after SCFE. Up to 47 per cent of unstable SCFE cases develop AVN of the femoral head, which dramatically accelerates the progression to arthritis.
How is post-Perthes or post-SCFE arthritis diagnosed?
Diagnosis is based on the childhood history, the characteristic radiographic appearance of the residual femoral head deformity, and the standard signs of secondary osteoarthritis. Mr Hussain will ask for any old childhood X-rays or hospital records if available. The standing AP pelvic X-ray shows the diagnostic features: coxa magna and aspherical head in post-Perthes, posterior femoral head slip and short femoral neck in post-SCFE.
The childhood history is the strongest clue. Many adults remember being treated with a brace, traction, or surgery as children, even if the diagnosis label is hazy. Others know only that they limped or had trouble keeping up at school. Old hospital records and X-rays are valuable when available.
Investigations used:
- Standing AP pelvic X-ray. Shows the characteristic residual deformity. Post-Perthes hips show coxa magna (an enlarged femoral head), aspherical head, short neck, and sometimes lateralisation. Post-SCFE hips show a femoral head that sits behind and below the femoral neck, with a "pistol grip" deformity.
- Frog-leg lateral or Dunn lateral view. Essential for measuring the alpha angle and demonstrating the residual deformity. Post-SCFE hips classically have a high alpha angle.
- Kellgren-Lawrence grading. The standard 1 to 4 scale for grading the secondary osteoarthritis that has developed on top of the childhood deformity.
- MRI. Used in younger patients to assess labral tears, cartilage damage, and any residual avascular necrosis. Important when considering hip arthroscopy or joint preservation surgery.
- CT scan. Used for surgical planning, particularly to map the 3D bony deformity before hip replacement. Helps anticipate the need for specialised implants or adjunctive osteotomies.
- Old childhood imaging. If available, original Perthes or SCFE X-rays, operative notes, and follow-up imaging help understand the disease severity and predict surgical complexity.
Can post-Perthes or post-SCFE arthritis be treated without surgery?
Yes, in the early stages. The same NICE NG226 first-line measures used for primary osteoarthritis (structured exercise, weight management, topical or oral NSAIDs) apply and can control symptoms for months to years. However, the underlying childhood deformity cannot be reversed, and most patients eventually need hip replacement or, in selected younger cases, joint-preserving surgery.
Conservative care is the right first step for adult post-Perthes or post-SCFE hip symptoms. The framework is the same as for primary osteoarthritis:
- Therapeutic exercise. Tailored physiotherapy combining hip strengthening, range-of-motion work, and aerobic exercise. Posterolateral hip strengthening particularly helps the abductor function that is often weak after childhood disease.
- Weight management. Reduces hip joint loading and slows symptom progression. Particularly important in patients with bilateral childhood disease.
- Topical NSAIDs. Preferred over oral NSAIDs because of fewer systemic side effects.
- Oral NSAIDs. Used at the lowest effective dose for symptom flares.
- Activity modification. Pivoting and twisting sports often provoke symptoms; modifying or substituting activities can extend the period before surgery is needed.
- Image-guided intra-articular injection. Both diagnostic (confirms the hip as the source of pain) and therapeutic. Particularly useful in younger patients to buy time before surgery.
- Joint-preserving surgery (selected cases). Hip arthroscopy with femoral osteoplasty can address the secondary impingement in some patients with preserved cartilage. Surgical hip dislocation with femoral osteochondroplasty (Ganz osteotomy) is offered at specialist hip preservation centres for selected cases. Mr Hussain refers these patients to a dedicated hip preservation surgeon.
For most patients with childhood-onset hip arthritis, conservative care delays rather than prevents the eventual need for hip replacement.
If you take prescribed medication, particularly blood-thinners or anti-inflammatories, please review Mr Hussain's patient guide on medications to pause before hip or knee surgery as you approach a surgical decision.
When should I consider hip replacement after Perthes or SCFE?
Hip replacement becomes the right choice when conservative measures stop controlling symptoms, when night pain disrupts sleep, when walking distance is reduced, and when imaging shows established cartilage loss. Because these patients are typically younger than primary OA patients, the threshold is often set by impact on work, family, and sport rather than chronological age.
The decision tree is similar to primary osteoarthritis but tilts toward earlier intervention because these patients are typically younger and more active. NICE NG226 frames the referral threshold as "symptoms have a substantial impact on quality of life and non-surgical management is ineffective or unsuitable".
Practical markers Mr Hussain looks for at consultation:
- Pain that wakes you at night, more than twice a week
- Walking distance reduced to under 100 metres before needing to stop
- Worsening limp affecting work or daily life
- Loss of internal rotation interfering with dressing, sitting, or driving
- Three to six months of structured physiotherapy and medication that has not controlled symptoms
- Imaging showing Kellgren-Lawrence Grade 3 or 4 secondary arthritis
- Failed prior hip arthroscopy or joint-preserving surgery
- Withdrawal from sport, work, or family activities
Modern hip replacement implants survive well in younger patients (around 92 per cent at 20 years in the 2026 Lancet meta-analysis), so age alone is not a reason to defer surgery beyond what symptoms warrant. Waiting through years of severe pain at the cost of weight gain, muscle loss, and lost function does not improve eventual surgical outcomes.
Private consultations with Mr Hussain are available at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston, and Harborne Hospital. See the private consultation and surgery fees page for pricing and recognised insurers, or book a consultation directly.
Hip replacement or hip resurfacing after Perthes or SCFE: which is right for me?
Total hip replacement is the standard surgical treatment for adult arthritis after childhood hip disease. Hip resurfacing can be a strong option for selected younger active men with mild post-Perthes or post-SCFE deformity, preserved femoral head bone quality, no AVN, and an adequate femoral head size. The Stulberg or slip-severity classification of the original disease and the modern imaging both guide the choice.
Mr Hussain trained in both hip replacement and hip resurfacing and is one of relatively few UK surgeons who offer both approaches in this group. The decision depends on age, sex, residual deformity, bone quality, and any associated AVN.
Total Hip Replacement
The damaged femoral head and acetabulum are both replaced. Pre-operative CT planning addresses residual bony deformity, leg length discrepancy, and any abnormal femoral version. Specialist implants and occasionally adjunctive subtrochanteric osteotomy are used for severe deformity.
- Standard for post-Perthes or post-SCFE arthritis
- Pre-operative CT planning for complex anatomy
- Subtrochanteric osteotomy for severe deformity in selected cases
- Modern series report 91 to 99 per cent survivorship at 10 years
- Comparable function to primary OA at follow-up
Hip Resurfacing
Possible in selected younger active men with mild residual deformity, preserved femoral head bone quality (no AVN), and adequate femoral head size. Resurfacing preserves bone for the future and gives lower dislocation rates than total replacement, particularly useful in young patients with bilateral disease who may face multiple operations over their lifetime.
- Selected younger active men with mild post-Perthes or post-SCFE
- Requires preserved femoral head bone (no AVN) and adequate head size
- Not appropriate for severe deformity, AVN, or short femoral neck
- Preserves bone for future revision options
- Lower dislocation rate than total replacement
For a deeper comparison covering recovery, return to sport, and implant choice, read Mr Hussain's patient guide on hip resurfacing versus total hip replacement. Active patients considering resurfacing may also find returning to sport after hip resurfacing useful for setting realistic expectations.
How successful is hip replacement after Perthes or SCFE?
Total hip replacement gives excellent pain relief and function in post-Perthes and post-SCFE patients, with modern series reporting 10-year survivorship of 91 to 99 per cent. Outcomes approach those of primary osteoarthritis once the technical demands of the childhood deformity are addressed with pre-operative planning and the right implants.
The historical view that hip replacement after childhood disease produced poorer outcomes has been superseded by modern series using contemporary implants, ceramic bearings, and dual-mobility options. Survivorship in young post-Perthes and post-SCFE patients is now broadly comparable with primary osteoarthritis at the same follow-up.
Expertise in post-Perthes and post-SCFE hip surgery in Birmingham
Consultant at the Royal Orthopaedic Hospital
Mr Hussain practises at the Royal Orthopaedic Hospital Birmingham, one of the largest specialist orthopaedic hospitals in Europe, alongside Priory Hospital Edgbaston and Harborne Hospital.
3,000+ arthroplasty cases
From a total of more than 5,000 procedures performed, giving the operative volume and case complexity required for consistently excellent outcomes. Read more about Mr Hussain's training and background.
British Hip Society Travelling Fellowship
Trained at ENDO-Klinik Hamburg under Professor Thorsten Gehrke and Professor Mustafa Citak, the international reference centre for complex hip surgery.
Both hip replacement and hip resurfacing
Many surgeons offer only one technique. Mr Hussain trained in both, allowing the choice to be tailored to the individual patient rather than to a single technique.
Doctify Outstanding Patient Experience 2024, 2025, and 2026
Awarded in three consecutive years, recognising consistently high patient-reported outcomes and communication.
4.98 out of 5 from verified reviews on Doctify. Outstanding Patient Experience Award 2024, 2025, and 2026.
Frequently asked questions about childhood hip disorders in adults
For more questions about surgery, recovery, fees, and what to expect, see the full frequently asked questions page or read recent patient testimonials.