HIP PAIN IN CHILDREN

The clinical challenge in paediatric hip pain is to distinguish urgent conditions such as infection of the hip joint from the more common irritable hip. Transient synovitis is one of the most common causes in children over 3 years of age but it has similar early symptoms to septic arthritis.

Transient synovitis and septic arthritis are the most common causes of hip pain in young children. Hip pain may be caused by conditions unique to the growing skeleton, including Perthes’ disease, slipped capital femoral epiphysis (SCFE) and apophyseal avulsion fractures of the pelvis. The relative likelihood of the different causes of hip pain varies with age.

The most common and significant causes of hip pain in children are:

  • Transient synovitis (irritable hip) peaking at 3-8 years.
  • Septic arthritis – any age (peaking at 0-6 years).
  • Perthes’ disease (3-12 years peaking at 5-7 years).
  • SCFE (early adolescence – usually in obese children).

Perthes’ disease also known as Legg-Calve-Perthes disease or coxa plana is a disease of the hip joint which causes softening and damage to the top of the thigh bone (femoral head) which leads to pain and limping. Perthes’ disease commonly affects children aged between the age of 4 and 8 years and usually occurs in one hip. Over time the bone gradually heals and reforms as the child grows but this can take between two and five years.

The aim of physiotherapy is to ensure that the femoral head regrows back into its normal shape to restore hip function and enhance mobility and quality of life.

What causes Perthes’ disease?

Perthes’ disease is caused by a reduced blood supply to the femoral head but the reason for this is unknown. A lack of blood supply means there is not enough oxygen and nutrients to the bone and so the bone cells die. This results in a flattened rather than rounded femoral head, which can fail to fit properly inside the hip socket and affects movement of the hip.

What is the treatment for Perthes’ disease?

There is no consensus for the optimum treatment. The aim of treatment is to maintain the sphericity of the femoral head and the congruency of the femur-acetabulum relationship to prevent secondary degenerative arthritis. Early diagnosis and management can help prevent the collapse of the femoral head, progressive femoral head deformity, and impingement.

Children who have a skeletal age of 6.0 years or less at the onset of the disease do well without treatment.Operative treatment should be considered in children who are six years old or older and have over 50% femoral head necrosis when the diagnosis is made.

Physiotherapy
Physiotherapy using muscle strengthening and stretching exercises, produces significant improvement in articular range of motion, muscular strength and articular dysfunction, but these improvements are not seen on X-ray.

What is hip dysplasia?
The hip is a ball-and-socket joint. Normally, the ball at the top of the thigh bone fits into the hip socket. Hip dysplasia occurs when the hip joint has not developed properly and the socket (acetabulum) is too shallow. This allows the ball (femoral head) to slip partially or completely out of the joint. Hip dysplasia ranges from a mild abnormality to a complete dislocation of the hip.
Severe cases of hip dysplasia are usually diagnosed during a routine screening within the first few months of a baby’s life. Other times, the problem may only become noticeable as a child grows and becomes more active.
Hip dysplasia is a treatable condition. However, if left untreated, it can cause irreversible damage that will cause pain and loss of function later in life. It is the leading cause of early arthritis of the hip before the age of 60. The severity of the condition and catching it late increase the risk of arthritis. Therefore, monitoring and early intervention are both important to reduce a child’s risk of pain and disability in adulthood.
Who is affected?
Hip dysplasia can affect anyone at any age. Although it is believed to develop around birth, a child with mild dysplasia may not have symptoms for years, or even decades.
Hip dysplasia in babies is known as infant developmental dysplasia of the hip (DDH).
When diagnosed in adolescents and young adults, it is sometimes called acetabular dysplasia.
The age at which older kids and young adults with hip dysplasia begin to notice symptoms depend on the severity of the condition and their activity level. Athletes who place a lot of load on their hips by participating in dance, hockey, football, soccer, or track and field may experience symptoms sooner.
Undiagnosed hip dysplasia caused such severe knee pain, this former track star sometimes had trouble walking after competitions. With surgery behind her, and a degree in medicine in the works, she has returned to the sport she loves.
Girls and women are two to four times more likely than boys to have hip dysplasia. It also tends to affect first-born children and those who have a close family member with hip problems. Some people with hip dysplasia are affected in only one hip while others have it in both hips.
In boys, the condition tends to be accompanied by other hip problems. These include acetabular retroversion (when the hip socket grows too far over the head of the femur) or CAM lesions (extra bone growth on the surface of the bone that causes extra friction and joint damage).
Hip dysplasia is sometimes confused with hip impingement, which occurs when extra bone grow on the acetabulum or femoral head. The irregular shape creates friction within the joint and wears down cartilage. Some patients have both conditions, both of which cause hip pain and are easy to confuse. However, they are different issues that require different treatments.
In a healthy hip joint, the head the femur fits comfortably inside the hip socket. With hip dysplasia, children’s hips are prone to partially or fully dislocate. Partial dislocation is also known as subluxation.
Generally speaking, treating hip dysplasia as early as possible can minimize joint damage and reduce the chance of early onset arthritis. Treatment options can vary from minimally invasive procedures as well as open surgical techniques to help treat patients of all ages.

For more information on hip pain in children or to discuss your child’s symptoms, please do not hesitate to get in touch via our appointments page.

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