🔑 Key Learning

  • Developmental dysplasia of the hip
    • 0-3 years
    • Clinical features: Barlow, Ortolani positive. 
  • Legg-Calve-Perthes disease
    • 4-8 years
    • Clinical features: pain, stiffness, reduced ROM (esp. aBduction and internal rotation)
    • X-ray: widened joint space, flattening of the femoral head
  • Slipped upper femoral epiphysis (SUFE)
    • 10-15 years
    • RFs: Overweight
  • Transient synovitis
    • 2-10 years
    • HPc: recent viral illness
  • Septic arthritis - Always rule out septic arthritis in any child with fever and hip pain.

👶 Developmental Dysplasia of the Hip (DDH)

Age range: 0–3 years

👀 Clinical Features

  • Leg length discrepancy
  • Restricted hip abduction
  • Positive Barlow's and Ortolani’s signs:
    • Barlow’s sign positive - aDduct the hip with posterior pressure on the knee - a palpable sensation of subluxation/dislocation
    • Ortolani’s sign positive - flex the hips and knees and apply anterior pressure on the greater trochanters - a clunk is felt when the femoral head is relocated into the acetabulum 

🧪 Investigations

  • <6 months: Hip ultrasound
  • >6 months: AP pelvic X-ray

💊 Management

  • <6 months: Pavlik harness
  • 6–18 months: Closed reduction and hip spica
  • >18 months or failed treatment: Open reduction ± reconstruction

🦵 Legg-Calvé-Perthes Disease

🧬 Pathophysiology

  • Idiopathic avascular necrosis of the femoral head

Age range: 4–8 years

👀 Clinical Features

  • Limp (often painless)
  • Hip stiffness
  • ↓ ROM – especially abduction and internal rotation
  • Antalgic gait

🧪 Investigations

  • AP pelvis X-ray:
    • Early: widened joint space
    • Later: flattened femoral head
X ray of Legg–Calvé–Perthes disease of the right hip. Note the flattened femoral head and widened joint space. James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons

💊 Management

  • Analgesia, physiotherapy, orthopaedic follow-up
  • Surgery if severe deformity or older child

🦠 Transient Synovitis

🧬 Pathophysiology

  • Benign inflammation of synovium, often post-viral

Age range: 2–10 years

👀 Clinical Features

  • Sudden onset hip pain or limp
  • May follow recent URTI
  • ↓ ROM – esp. abduction
  • Child appears well, afebrile or low-grade fever

🧪 Investigations

  • Rule out septic arthritis: FBC/CRP, blood culture
  • Hip US: may show effusion

💊 Management

  • Rest and analgesia
  • Self-resolving in 1–2 weeks

🍩 Slipped Upper Femoral Epiphysis (SUFE)

🧬 Pathophysiology

  • Posteroinferior slippage of femoral epiphysis on metaphysis

Age range: 10–15 years

⚠️ Risk Factors

  • Obesity
  • Male sex
  • 20% bilateral

👀 Clinical Features

  • Hip/knee pain
  • Limp
  • ↓ ROM – especially internal rotation and flexion

🧪 Investigations

  • AP and frog-leg lateral pelvis X-rays
  • Look for displacement and physeal widening

💊 Management

  • Urgent surgical fixation (e.g. in-situ pinning) to prevent avascular necrosis
  • Non-weight-bearing pre-op

📝 Exam Clues & Clinchers

  • Barlow + Ortolani positive in newborn → DDH
  • 4–8 yr old, painless limp + restricted abduction/internal rotation → Perthes
  • Post-viral limp in 6 yr old, afebrile → Transient synovitis
  • Obese 12 yr old with knee pain and reduced hip IR → SUFE
  • Febrile child with acutely irritable hip, ↑CRP/WCC → always rule out septic arthritis