The hip joint consists of the spherical head of the femur, the femoral head, and the acetabulum, which roofs the femoral head. The joint surfaces are covered with articular cartilage to allow smooth movement. As one of the largest joints in the human body, the hip joint plays an essential role in leg movement and walking.
The following describes conditions of the hip that typically occur in children and adolescents. Our pediatric orthopedist Priv.-Doz. Dr. Pestka will be happy to advise you in detail and individually on the individual diseases.
Hip joint dysplasia
Hip dysplasia describes a congenital malformation of the hip joint in which the acetabulum is insufficiently formed. This subsequently leads to a disturbance in the formation of the femoral head and an increased likelihood of dislocation of the hip joint. Around four percent of all newborns are affected, most often girls.
Known risk factors for the occurrence of hip dysplasia are female gender, malposition of the child in utero and the presence of the disease in relatives.
Ultrasound examination of the hip joints (Graf's technique) is an integral part of the U3 examination performed by the pediatrician. The acetabulum and the femoral head are displayed and certain angles are measured according to a standardized scheme. Should abnormalities be found here, Priv.-Doz. Dr. Pestka can initiate appropriate therapy to confirm the diagnosis.
The goal of treatment of hip dysplasia is to improve the roofing of the femoral head by the acetabulum.
If the diagnosis is made early enough, conservative measures are usually sufficient. In this case, therapy is initiated by means of spreader pants (e.g. Tübingen splint) for post-maturation (retention) of the hip joints. In severe cases, a hip that is about to dislocate can be treated by means of repositioning (e.g. with a Pavlik bandage). Depending on the severity of the findings, consistent therapy over several months is usually necessary. The therapy is only finished when a satisfactory post-maturation of the affected hip joint has been achieved.
Perthes disease
Perthes disease, also called idiopathic infantile femoral head necrosis, describes the destruction of bone tissue of the femoral head, most likely due to a circulatory disorder. As it progresses, small bone fractures and instability of the femoral head may occur. Mostly this disease occurs in boys between the age of 4 and 8. The cause is not yet fully understood.
Signs of Perthes disease may include:
- Load-dependent hip and groin pain
- Schonhinken
- Limited mobility
Typical complaints are hip pain that occurs during weight-bearing and sometimes radiates into the thigh and knee. As a result, a limping motion occurs. In addition, rotational movements of the hip in particular are restricted. In about one fifth of patients, both hip joints are affected at the same time.
On physical examination, Perthes disease is noticeable by the so-called positive quad sign, in which the foot of the affected leg is placed on the knee of the other leg. If there is pain or a large distance between the knee of the affected leg and the couch, the sign is positive.
Typical changes in the femoral head are visible on x-ray . Early stages of the disease can also be detected by magnetic resonance imaging,
The therapy of Perthes disease depends on the age of the affected person and the stage of the disease. In general, the earlier the disease is detected and treated, the better the prognosis.
The following therapies are possible:
- Protection
- Physiotherapy
- Regular controls
- Operation
In young patients and stable hip joints, conservative therapy is indicated, in which the focus is on relieving the hip joint. This can be achieved, for example, with the aid of crutches and avoidance of stress. Sports are initially prohibited for the affected children.
Epiphyseolysis capitis femoris (femoral head dislocation)
Epiphyses refer to the growth plates of long bones where length growth takes place. In epiphysis capitis femoris, there is a loosening of the growth plate at the femoral head and, if necessary, subsequent detachment and tilting of the femoral head. The disease mostly affects overweight male adolescents. This is one of the few pediatric orthopedic emergencies.
Signs of epiphyseolysis capitis femoris may include:
- Groin pain
- Radiation in thigh and knee
- Limited mobility in the hip joint
- Schonhinken
This disease can be divided into an insidious and a sudden form. In the case of the acute form, in which there is a sudden slipping of the femoral head, severe pain and a shortened leg are typical.
The loosening of the growth plate can be confirmed by an X-ray. Since both hip joints are affected in about half of all sufferers, the opposite side should also be x-rayed.
Epiphyseolysis capitis femoris is operated on in any case to prevent further slippage of the femoral head. When the femoral head slips off, the blood supply is interrupted and there is a risk of bone tissue death. Prophylactic stabilization of the opposite side is indicated in every case.
Coxitis fugax (hip flare)
Coxitis fugax is a temporary, self-limiting inflammation of the hip joint, also called "hip rhinitis", which often occurs following a cold. It mainly enters children between the ages of 3 and 9.
Signs of coxitis fugax may include:
- unilateral groin, hip, knee pain
- Limited mobility
- Schonhinken
In terms of symptoms, the disease is similar to Perthes' disease. An effusion in the hip joint can be detected in the ultrasound image, whereas no abnormalities can usually be detected in the X-ray image.
Due to the similarity to Perthes disease and bacterial inflammation of the hip joint, exclusion of these diseases is essential before starting therapy.
The following therapies are necessary:
- Relief
- Painkiller
Treatment of coxitis fugax includes relief of the hip joint and taking painkillers. As a rule, the symptoms disappear within a few days to a maximum of two weeks.
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