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.

Definition

Childhood hip disorders are structural or inflammatory problems of the developing hip that commonly present with a limp, restricted movement or hip, thigh or knee pain. The principal structural diagnoses are developmental dysplasia of the hip, Perthes disease and slipped upper femoral epiphysis.

First principles

Age narrows the mechanism

In an infant, think of abnormal hip development or instability; in a school-age child, interrupted femoral-head blood supply (Perthes disease); and around adolescence, failure of the proximal femoral physis (slipped upper femoral epiphysis). Age is a discriminator, not a diagnosis: infection, injury and malignancy can occur at any age.

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