Children's hip disorders

Question 1

What are the risk factors for DDH?

Answer 1

Female
Firstborn
Left hip
Family history
Breech position in utero or during birth
Other MSK abnormalities e.g. club foot

Question 2

What does DDH stand for?

Answer 2

Developmental dysplasia of the hip

Question 3

What is DDH?

Answer 3

Dislocation or subluxation of the femoral head in utero resulting in abnormal development of the hip

Question 4

What is the result of untreated DDH?

Answer 4

Shallow acetabulum/false acetabulum
Reduced surface contact resulting in severe arthritis
This affects mobility and gait, often severely

Question 5

What is Ortolani’s test?

Answer 5

Attempting to relocate a dislocated hip by abduction

Question 6

What is Barlow’s test?

Answer 6

Attempting to sublux or dislocate a hip by flexion adduction

Question 7

What signs on examination are indicative of a DDH?

Answer 7

Click/clunk on Barlow’s or Ortolani’s test
Shortened limb
Asymmetrical groin or thigh skin creases

Question 8

How does a Pavlik’s harness work?

Answer 8

Holds the hips in flexion and abduction, maintaining reduction

Question 9

How successful is Pavlik’s harness in treating DDH?

Answer 9

In children aged less than 4-6 months there is a success rate of 85-95%

Question 10

How long is a Pavlik’s harness worn for?

Answer 10

6 weeks

Question 11

How is DDH in children >18 months generally treated?

Answer 11

Open reduction

Question 12

What investigation should follow a positive Barlow’s or Ortolani’s test?

Answer 12

Ultrasound in <4-6 months (bone has not yet ossified so Xray is usually not helpful)

Question 13

What is the most common cause of childhood hip pain?

Answer 13

Transient synovitis

Question 14

What other diagnoses must be excluded in transient synovitis and how can they be excluded?

Answer 14

Septic arthritis (joint aspiration)
Osteomyelitis (MRI)
Perthes (Xray)
Juvenile idiopathic arthritis
Rheumatoid arthritis

Question 15

How is transient synovitis treated?

Answer 15

It is self-limiting, so rest and NSAIDs

Another diagnosis must be considered if this is not successful

Question 16

What can often precede a transient synovitis?

Answer 16

Upper respiratory tract infection

Question 17

What group of children are most commonly affected by Perthe’s?

Answer 17

Hyperactive boys
Short
Aged 4-9

Question 18

What is Perthe’s disease?

Answer 18

Idiopathic osteochondrosis of the femoral head

Question 19

How does Perthe’s disease cause problems?

Answer 19

There is avascular necrosis of the femoral head
This can result in femoral head collapse
Remodelling occurs and can result in osteoarthritis depending on the age of the child and the severity of the collapse
This can result in hip replacement in adolescence or early adulthood

Question 20

What is first line treatment of Perthe’s disease?

Answer 20

Regular Xray and avoidance of physical activity

Question 21

What percentage of Perthe’s disease can be maintained by regular Xray and avoidance of physical activity?

Answer 21

50% generally are successfully managed this way

Question 22

What changes can occur at the femoral head in Perthe’s disease?

Answer 22

It can become flattened, widened and ashperical

Question 23

What is SUFE?

Answer 23

Slipped upper femoral epiphysis - femoral head epiphysis slips inferiorly in relation to the femoral neck

Question 24

Who is most commonly affected by SUFE?

Answer 24

Overweight pre-pubertal boys

Question 25

Which conditions can predispose to SUFE?

Answer 25

Hypothyroidism

Renal disease

Question 26

What may precede a SUFE?

Answer 26

A growth spurt

Question 27

How common are bilateral SUFE’s?

Answer 27

1/3 of cases are bilateral

Question 28

How might a SUFE present?

Answer 28

Pain in groin or in knee

Limp

Question 29

Why might pain from a SUFE present only in the knee?

Answer 29

Obturator nerve supplies both the knee and the hip

Question 30

What is the predominant clinical sign in SUFE?

Answer 30

Loss of internal rotation

Question 31

What imaging should be ordered in suspected SUFE?

Answer 31

Both AP and lateral Xray

Question 32

What is the treatment of SUFE?

Answer 32

Pin the femoral head to prevent further slippage