Hip Pain in Children

Abstract

Background: Atraumatic hip pain in children is one of the most common symptoms with which pediatricians, orthopedists, and general practitioners are confronted, with an incidence of 148 cases per 100 000 persons per year.

Methods: This article is based on publications up to April 2019 that were retrieved by a selective search in the PubMed data- base, including case reports and reviews.

Results: Infants with fever often have purulent coxitis, which can be diagnosed by blood tests and ultrasonography. Toddlers and older children may suffer from painful restriction of motion of the hip joint, associated with limping (antalgic gait) or even the in- ability to walk. The main elements of the differential diagnosis in children aged 2-10 are coxitis fugax and idiopathic necrosis of the femoral head (Perthes disease). In children aged 10 and up, and in adolescents, slipped capital femoral epiphysis (SCFE) is typical. Bone tumors and rheumatic diseases must always be considered as well. The initial diagnostic steps on presentation of a child with restricted hip movement should be plain x-rays and joint ultrasonography for the detection of an effusion. Suspicion of a tumor is the main indication for tomographic imaging (computed tomography or magnetic resonance imaging).

Conclusion: The underlying cause of hip pain in children should be diagnosed early to avoid adverse sequelae.

Figure 1

Radiographic staging of Perthes disease (Waldenström classification) a) Early stage; b) condensation; c) fragmentation; d) reossification; e) healed

Figure 2

Radiographic diagnosis of slipped capital femoral epiphysis and its surgical management, showing the time course a) Preoperative anteroposterior (AP) pelvic radiograph; b) Preoperative true lateral view of the right hip; c) Preoperative true lateral view of the left hip; (pathological: slippage >50°); d) Postoperative AP pelvic radiograph after prophylactic in situ screw placement (right hip) and valgization–flexion–derotation osteotomy (Weber–Imhäuser osteotomy) (left hip); e) Postoperative axial view of the right hip with prophylactic in situ screw placement f) Postoperative axial view of the left hip with valgization–flexion–derotation osteotomy (Weber–Imhäuser osteotomy)

Figure 3

Measurements on a pelvic radiograph, showing the reference lines and angular measurements (AC and CE) in an assessment of hip dysplasia/displacement

Figure 4

Radiographic diagnosis of bilateral hip dysplasia and its surgical treatment with bilateral triple osteotomy a) Preoperative AP pelvic radiograph; b) postoperative pelvic radiograph showing right-side triple osteotomy with persistent left hip dysplasia; c) postoperative pelvic radiograph with additional left-side triple osteotomy (i.e., now bilateral osteotomies after initial bilateral dysplasia; in the time elapsed between the two procedures, some metal parts have been removed from the right acetabular osteotomy and bone remodeling has begun.