Knee pain as the initial symptom of slipped capital femoral epiphysis: An analysis of initial presentation and treatment

A retrospective review was performed of 106 patients to determine the effec t of knee pain as the initial complaint of slipped capital femoral epiphysi s (SCFE). Sixteen (15%) patients had a primary complaint of distal thigh or knee pain or both at initial presentation to our institution or to a refer ring physician. Ninety (85%) patients described primarily hip, groin, or pr oximal thigh discomfort. Of the 106 patients with SCFE, 65 patients receive d no operative treatment before being evaluated at our institution and were the subject of the remainder of the study. Of these, 15 (23%) patients had distal thigh or knee pain or both as their chief complaint (group I), and 50 (77%) patients had hip, groin, or proximal thigh pain (group II). There was no difference between the groups with respect to age, gender, or slip s tability. Group I patients were more likely to receive a misdiagnosis (p < 0.05) and undergo unnecessary or uninformative radiographs (p < 0.05). Addi tionally, patients in group I were found to have slips of greater radiograp hic severity (p < 0.05). Although not statistically sig significant, there was a trend for group I patients to experience a longer delay to diagnosis and to require a proximal femoral osteotomy as treatment for their slips. W e conclude that isolated distal thigh or knee pain or both is a common pres entation of SCFE. Furthermore, this symptom complex, when compared with the more classic presentation of SCFE, leads to higher rates of unnecessary ra diographs, misdiagnoses, and severe slips, potentially increasing long-term morbidity.