Paediatric Hip Problems

Question 1

What is developmental dysplasia of the hip (DDH)?

Answer 1

Dislocation or subluxation of the femoral head during perinatal period affecting subsequent development of hip joint

Question 2

What are the risk factors for DDH?

Answer 2

Female
Family history of DDH
Breech
First born
Downs syndrome
Talipes

Question 3

What are the consequences of untreated DDH?

Answer 3

Acetabulum becomes very shallow
In severe cases a false acetabulum occurs proximally –> shortened limb
Severe arthritis at a young age
Impaired gait/mobility

Question 4

How is DDH diagnosed?

Answer 4

Examination after birth

USS of hip

Question 5

What might been seen on examination of a baby with DDH?

Answer 5

Shortened leg
Asymmetric groin/thigh skin creases
Click/clunk on Barlow/Ortolani manoeuvres

Question 6

What is Barlow’s manoeuvre?

Answer 6

Dislocatable hip with flexion and posterior displacement

Question 7

What is Ortolani’s manoeuvre?

Answer 7

Reducing a dislocated hip with abduction and anterior displacement

Question 8

What would be seen on USS of a hip with DDH?

Answer 8

Dislocated/unstable hip

Shallow acetabulum

Question 9

What is the first line investigation for DDH in a baby over 4-6 months old?

Answer 9

Xray

Question 10

Why is xray not used in babies < 4 months old to look for DDH?

Answer 10

Femoral head epiphysis is not ossified so will not show up on xray

Question 11

What is the management of DDH?

Answer 11

Pavlik harness –> keeps hips flexed and abducted (maintaining reduction)
Full time for 6 weeks, then part time

Question 12

What is the most common cause of hip pain in children and when does it occur?

Answer 12

Transient synovitis of the hip
After viral URTI
Age 2-10, boys > girls

Question 13

What are the clinical features of transient synovitis of the hip?

Answer 13

History of recent URTI
Limp or reluctance to weight bare
May have mild fever but not systemically unwell

Question 14

Which investigations should be done for transient synovitis of the hip?

Answer 14

Xray –> exclude Perthes

CRP –> exclude septic arthritis

Question 15

What is the treatment and prognosis of transient synovitis of the hip?

Answer 15

NSAIDs and rest

Usually resolves in a few weeks

Question 16

What is Perthes disease?

Answer 16

Idiopathic osteochondritis of the femoral head

Question 17

Who gets Perthes disease?

Answer 17

Active boys, age 4-9, of short stature

Question 18

What is the pathophysiology of Perthes disease?

Answer 18

Transient loss of blood supply –> necrosis –> abnormal growth
Femoral head may collapse or fracture
–> early onset OA +/- hip replacement

Question 19

What are the clinical features of Perthes disease?

Answer 19

Unilateral pain + limp
Loss of internal rotation
Loss of abduction
–> +ve Trendellenburg (gluteal weakness)

Question 20

How is Perthes disease managed?

Answer 20

Regular xray observation + avoidance of physical activity

Question 21

What is SUFE?

Answer 21

Slipped Upper Femoral Epiphysis

- femoral head epiphysis slips inferiorly in relation to femoral neck

Question 22

Who gets SUFE?

Answer 22

Overweight, pre-pubertal, adolescent boys

Question 23

What are the clinical features of SUFE?

Answer 23

Pain –> may be in groin but often patients present PURELY WITH KNEE PAIN
Loss of internal rotation of hip is main clinical sign

Question 24

What is the management of SUFE?

Answer 24

Urgent surgery to pin femoral head + prevent further slippage
If severe, may require hip replacement in adolescence/early adulthood