18-year-old undergoes hip replacement in Singapore after rare condition

SINGAPORE – Mr Lutfhil Hadi Azman was just 12 when he began experiencing pain in his left leg in late 2019.

The pain was intermittent, surfacing especially when he would run or walk fast. A family doctor diagnosed the pain as muscle aches, prescribing him gel and painkillers for relief.

“I thought it was just muscle pain. If I felt the pain, I would just take painkillers,” said Mr Hadi, who is now 19.

He told The Straits Times he tried to remain “resilient” even as the discomfort continued to worsen, causing him to limp occasionally and even drive him to tears at times.

This persisted until January 2020, when a teacher noticed he was suffering and told him to see a doctor.

After a visit to the polyclinic, Mr Hadi was referred to the National University Hospital (NUH). There, Adjunct Associate Professor Andrew Lim – head of the hospital’s paediatric orthopaedic surgery division – diagnosed him with slipped capital femoral epiphysis (SCFE).

After conventional treatments for his condition failed, Mr Hadi in July 2025 became one of the youngest people in Singapore to get a hip replacement.

SCFE is a rare hip condition that typically affects children between the ages of 10 and 16. It occurs when the ball at the top of the thigh bone slips out of position at the growth plate, a layer of cartilage at the end of long bones in children and adolescents where bone growth occurs.

This causes pain in the affected hip as well as difficulty in bearing weight on the affected leg.

It affects adolescents almost exclusively as a result of the growth spurts young people experience during that time, said Prof Lim.

Once a person hits adulthood, the growth plate turns into bone and the slippage that causes SCFE cannot occur, he noted.

The condition affects about 10 in every 100,000 children, with NUH seeing about five cases a year.

While the exact cause of SCFE is not known, one risk factor is being overweight, said Prof Lim.

At the time, Mr Hadi weighed 66kg and was 151cm tall at 13 years old, putting his body mass index in the obese category.

Other risk factors include metabolic disorders such as hyperthyroidism – when an overactive thyroid creates and releases more hormones than needed – as well as Down syndrome, which is linked to such disorders.

To correct the condition, Mr Hadi underwent an operation in February 2020 to insert screws across the growth plate, to help keep the ball of the thigh bone in place and prevent further slippage.

However, the initial slip was severe and had affected the blood supply to the hip, causing the bone and cartilage to collapse in the subsequent months, Prof Lim noted.

A second surgery was done in August 2020 to reposition and replace the screws.

However, the collapse occurred again, and doctors removed the screws in December 2022 to monitor his condition and determine the best course of action.

Mr Hadi’s pain improved after the third surgery, but it quickly worsened and he had to rely more on crutches and a wheelchair to get around.

In December 2024, he was diagnosed with osteoarthritis of the hip, where wear and tear result in pain and stiffness as well as a limited range of motion in the joint.

It became clear that Mr Hadi needed a hip replacement – where damaged parts of the joint are replaced with prostheses.

While those who get hip replacements are typically aged 60 or older, in Mr Hadi’s case, the severity of his condition meant there was an urgent need for him to undergo surgery, Prof Lim said.

“Waiting was not an option. At 18 years old, he cannot wait for another 40 years before he does it,” he added.

Prof Lim collaborated with Adjunct Assistant Professor Barry Tan, who heads the adult reconstruction and joint replacement surgery division at NUH’s orthopaedic surgery department.

Their combined paediatric and adult orthopaedic surgery expertise allowed for the treatment of an adolescent patient with osteoarthritis, which is usually seen in older adults.

CT scans provided the doctors with a better understanding of Mr Hadi’s anatomy, and he underwent a successful robot-assisted surgery to replace his hip in July 2025.

The procedure also safely lengthened his left leg, which had become 4cm shorter than his right leg as a result of his deteriorating condition.

Prof Lim said that records show that Mr Hadi – who was able to walk normally the day after his surgery – is among the youngest patients to have undergone the procedure at NUH.

Mr Hadi, who now works at a fast-food restaurant in Jurong West, said he is able to stay on his feet during his eight-hour shifts without feeling any pain.

He went camping not long after his operation and hopes to go fishing on a boat out at sea soon, he said.

“Maybe I will even get my motorbike licence,” he added.