Paediatrics

Childhood Hip Disorders

Childhood hip disorders present through age-specific mechanisms: developmental dysplasia in infancy, Perthes disease in the school-age child and slipped upper femoral epiphysis in adolescence; all can present as a limp or referred knee pain.

In a nutshell

Sort a limping child by age, but clear infection and instability first: developmental dysplasia in infancy, Perthes disease in the school-age child and slipped upper femoral epiphysis in the adolescent. Hip disease may present as knee pain. Use ultrasound for the screened infant hip, age-appropriate radiographs for older children, and urgent paediatric orthopaedic referral for suspected slipped epiphysis.

Classic presentation

A breech infant has limited hip abduction, a 6-year-old has a persistent limp with restricted internal rotation, or an overweight adolescent has knee pain and an externally rotated leg.

Key points

Fever, systemic illness or inability to weight-bear means urgent assessment for infection or an unstable slip.
Always examine the hip in unexplained knee pain or limp.
NIPE hip screening uses clinical examination plus selective ultrasound; follow the current NHS England timing pathway.
Perthes disease is a specialist orthopaedic diagnosis requiring range-of-motion preservation and serial follow-up.
Suspected slipped upper femoral epiphysis requires non-weight-bearing and urgent orthopaedic assessment; do not force the hip.

First-line investigation

Age-appropriate hip assessment: NIPE/selective ultrasound in infants, or bilateral hip/pelvic radiographs in older children, with infection assessment when acutely unwell.

Management

Clear emergencies

Same-day urgent assessment for fever, systemic illness, severe pain or inability to weight-bear; treat suspected infection as an emergency.^4,5
Keep suspected slipped upper femoral epiphysis non-weight-bearing and arrange urgent paediatric orthopaedic review.³

Examine and image by age

Examine both hips and the knee; use the NIPE pathway and selective ultrasound for the infant hip.^1,6
Use specialist-planned bilateral radiographs for suspected adolescent slip and avoid forcing a painful or unstable hip into position.³

Use the diagnosis-specific pathway

DDH, Perthes disease and slipped epiphysis each need paediatric orthopaedic treatment and follow-up; a delayed diagnosis increases the risk of deformity and early osteoarthritis.^1,2,9

Safety-net

Reassess urgently for new fever, worsening pain, night symptoms, a new inability to weight-bear or a deteriorating gait, and ensure imaging and specialist appointments are completed.^1,7,2

Exam traps

Knee-only pain can be referred from the hip, especially in slipped upper femoral epiphysis.
Transient synovitis is a diagnosis of exclusion, not a reason to ignore fever or inability to weight-bear.
A normal early radiograph does not end evaluation when symptoms and examination remain concerning; use specialist follow-up.
Do not force an unstable adolescent hip into a painful imaging position.

Illustrations

Perthes disease on pelvic radiographyAP pelvic radiograph showing unilateral sclerosis, fragmentation and flattening of the capital femoral epiphysis in Legg-Calvé-Perthes disease; retain source attribution while image-quality remediation remains separate.J. Lengerke, Wikimedia Commons · Public domain

Key sources

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.