Hip problems in children

Question 1

Often picked up on newborn examination
Barlow’s test, Ortolani’s test are positive
Unequal skin folds/leg length

Answer 1

Developmental Dysplasia of the Hip (DDH)

Question 2

Typical age group = 2-10 years
Acute hip pain associated with viral infection
Commonest cause of hip pain in children

Answer 2

Transient Synovitis (irritable hip)

Question 3

Degenerative condition affecting the ages of 4-8 years.
Due to avascular necrosis of the femoral head

5 times more common in boys. 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

Answer 3

Perthes disease

Question 4

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

Answer 4

Slipped Upper Femoral Epiphysis

Question 5

Arthritis in patient <16 years old and lasts for >3 months. “Pauciarticular” if <4 joints are affected.

Features:
- joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows
- limp
- ANA may be positive

Answer 5

Juvenile idiopathic arthritis (JIA)

Question 6

Acute hip pain associated with systemic upset e.g. pyrexia. Inability/severe limitation of affected joint

Answer 6

septic arthritis