Hip problems in children

The table below provides a brief summary of the potential causes of hip problems in children

Condition	Notes
Development dysplasia of the hip	Often picked up on newborn examination Barlow's test, Ortolani's test are positive Unequal skin folds/leg length
Transient synovitis (irritable hip)	Typical age group = 2-10 years Acute hip pain associated with viral infection Commonest cause of hip pain in children
Perthes disease	Perthes disease is a degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head Perthes disease is 5 times more common in boys. Around 10% of cases are bilateral Features hip pain: develops progressively over a few weeks limp stiffness and reduced range of hip movement x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
Slipped upper femoral epiphysis	Typical age group = 10-15 years More common in obese children and boys Displacement of the femoral head epiphysis postero-inferiorly Bilateral slip in 20% of cases May present acutely following trauma or more commonly with chronic, persistent symptoms Features knee or distal thigh pain is common loss of internal rotation of the leg in flexion
Juvenile idiopathic arthritis (JIA)	Preferred to the older term juvenile chronic arthritis, describes arthritis occurring in someone who is less than 16 years old that lasts for more than three months. Pauciarticular JIA refers to cases where 4 or less joints are affected. It accounts for around 60% of cases of JIA Features of pauciarticular JIA joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows limp ANA may be positive in JIA - associated with anterior uveitis
Septic arthritis	Acute hip pain associated with systemic upset e.g. pyrexia. Inability/severe limitation of affected joint

Image gallery


© Image used on license from Radiopaedia

Perthes disease - both femoral epiphyses show extensive destruction, the acetabula are deformed


© Image used on license from Radiopaedia

Perthes disease - bilateral disease


© Image used on license from Radiopaedia

Slipped upper femoral epiphysis - left side


© Image used on license from Radiopaedia

Slipped upper femoral epiphysis - left side