Ortho - Hip Pain Flashcards
How does hip pain present?
- Limp
- Refusal to use affected leg
- Refusal to weight bear
- Inability to walk
- Pain
- Swollen or tender joint
What are some causes of hip pain in different age groups?
0-4 years
- Septic arthritis
- Transient sinovitis
- Developmental dysplasia of the hip (DDH)
5-10 years
- Septic arthritis
- Transient sinovitis
- Perthes disease
10-16 years
- Septic arthritis
- Juvenile idiopathic arthritis
- Slipped upper femoral epiphysis (SUFE)
What are the red flags for hip pain?
- Under 3
- Fever
- Waking at night with pain
- Weight loss
- Anorexia
- Night sweats
- Fatigue
- Persistent pain
- Stiffness in the morning
- Swollen or red joint
What is the criteria for urgent referral in a limping child?
- Under 3
- Older than 9 with restricted or painful hip
- Can’t weight bear
- Neurovascular compromise
- Severe pain or agitation
- Red flags for serious pathology
- Abuse suspicion
How is hip pain managed?
- CRP and ESR for JIA and septic arthritis
- X-rays for fractures and SUFE
- USS - effusion in joint
- Joint aspiration - septic arthritis
- MRI - osteomyelitis
When is septic arthritis most common?
Under 4
Can happen at any age
Why is septic arthritis an emergency?
Infection can destroy joint and cause systemic illness
10% mortality
What is septic arthritis a common complication of?
Joint replacement
1% of hip and knee
Higher in revision surgeries
How does septic arthritis present?
Usually single joint
- Rapid onset
- Hot, red, swollen and painful joint
- Refusing to weight bear
- Stiffness and reduced range of motion
- Systemic symptoms e.g. fever, lethargy and sepsis
Subtle in young kids so always consider
What are the common causes of septic arthritis?
Staphylococcus aureus most common
- Neiserria gonorrhoea
- Group A streptococcus (strep pyo)
- Haemophilus influenzae
- Escherichia coli
When is Neisseria gonorrhoea more likely in septic arthritis?
Sexually active teenagers
What are some differential diagnoses of septic arthritis?
Transient synovitis
Perthes disease
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis
How is septic arthritis managed?
Low threshold for treatment until excluded with joint fluid examination
Urgent admission and ortho team involvement
Aspirate joint prior to antibiotics if possible
Send sample for
- Gram staining
- Crystal microscopy
- Culture
- Antibiotic sensitivites
Empiral IV antibiotics until sensitivites known
Surgical drainage and washout of joint
What is the joint fluid like in septic arthritis?
Purulent
How long are antibiotics continued for in septic arthritis?
3-6 weeks
What causes transient synovitis?
Temporary irritation and inflammation in the synovial membrane of the joint
What sign can help rule out septic arthritis in transient synovitis?
Typically no fever
How does transient synovitis present?
Occurs within a few weeks of viral illness
- Limp
- Refusal to weight bear
- Groin or hip pain
- Mild low grade temperature
How is transient synovitis managed?
Symptomatic treatment with simple analgesia
Exclude other pathology
Safety net advice to attend A&E if symptoms worsen or develop a fever
Followed up at 48 hours and 1 week to ensure symptoms are improving
When can transient synovitis be managed in primary care?
If present for less than 48 hours
What is the prognosis of transient synovitis?
Significant improvement after 24-48 hours
Resolve fully within 1-2 weeks without lasting problems
Recur in 20% of patients
What does perthes disease involve?
Disruption to blood flow of the femoral head leading to avascular necrosis
This affects the epiphysis of the femur
What age are children affected by Perthes disease?
4-12 years
Mainly between 5-8 years
More boys affected than girls
What causes perthes disease?
No clear cause of trigger
May be due to repetitive mechanical stress to the epiphysis interrupting blood supply
