Hip pain (peds)

This page is for pediatric patients. For adult patients, see: hip pain.

Background

Hip anatomy.

Extracapsular ligaments (anterior right hip).

Extracapsular ligaments (posterior right hip).

• It can be difficult to differentiate hip from knee pain in children

Clinical Features

• Hip pain
• +/- Limp

Differential Diagnosis

Pediatric hip pain

• Acute rheumatic fever
• Developmental dysplasia of hip
• Femur fracture
• Juvenile idiopathic arthritis
• Legg-Calve-Perthes disease
• Septic arthritis of the hip (peds)
  • Lyme disease arthritis
• Slipped capital femoral epiphysis
• Transient (toxic) synovitis
• Osteosarcoma

Evaluation

AP hip x-ray.

Left hip effusion

X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.

A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).

Workup

• X-ray hip (AP & bilateral Frog leg), femur, knee
• Consider CBC, ESR, CRP
• Consider:
  • Ultrasound to evaluate for effusion
  • CT or MRI to evaluate for abscess

Kocher Criteria for septic arthritis of the hip

• ESR > 40 mm/hr
• WBC > 12,000/microliter
• Refusal or inability to weight bear on affected joint
• Fever 38.5° C or greater

Number of Kocher Criteria	Chance of Septic Joint
1	3%
2	40%
3	93%
4	99%

Management

• Depends on diagnosis
  • Transient (toxic) synovitis is diagnosis of exclusion

Disposition

• Depends on diagnosis
  • Transient (toxic) synovitis is diagnosis of exclusion

See Also

• Limp (Peds)
• Hip Pain