This document discusses several common causes of hip pain in adolescents, including transient synovitis, Perthes disease, slipped capital femoral epiphysis, septic arthritis, tuberculous arthritis, and idiopathic chondrolysis. For each condition, the document outlines typical presenting symptoms, potential causes, diagnostic methods like x-rays and blood tests, and treatment approaches such as rest, traction, surgery, or antibiotics. Common complications are also listed. The goal of treatment for many of these hip disorders is to relieve pain, prevent deformity, and restore hip function in adolescent patients.

1. ADOLESCENT HIPADOLESCENT HIPADOLESCENT HIPADOLESCENT HIP

5. What does the parents
complain of ?
Limping
Pain in hip
Knee pain

6. What could it be due to ?
 Transient synovitis
 Perthes disease
 Slipped capital femoral epiphysis
 Idiopathic Chondrolysis
 Septic arthritis
 Tuberculous arthritis
 Trauma
 Tumours

7. TRANSIENT SYNOVITIS HIPTRANSIENT SYNOVITIS HIP
Benign self limiting
Most common cause of hip
pain in children

8. AETIOLOGYAETIOLOGY
 Unknown
 Trauma
 Allergic manifestation
 infection

9. SYNOVITIS HIPSYNOVITIS HIP
 Unilateral hip pain
 3 – 18 years
 Limb and antalgic gait
 ROM restricted

10. DIAGNOSIS IS BY
EXCLUSION

11. INVESTIGATIONSINVESTIGATIONS
Usually within normal limits
USG – joint effusion

12. Complete resolution is theComplete resolution is the
rule usually within 3-4rule usually within 3-4
weeksweeks

13. TREATMENTTREATMENT
 Strict bed rest and non-weight
bearing
 Skin traction – recurrent symptoms

14. SEPTIC ARTHRITISSEPTIC ARTHRITIS
True orthopaedic emergency
Any age – common in infants
and children

15. Clinical features
Febrile and toxic
Swollen and painful joint
Pseudoparalysis

16. The key to treatment
is early diagnosis
with a high index of
suspicion and early
removal of pus from
the joint.

17. Investigations
Raised total count
Raised ESR
Raised CRP

18. TREATMENT
Early diagnosis
Arthrotomy
Antibiotics
Splintage – rest -- traction

19. Complications
Osteomyelitis
Dislocation
Avascular necrosis
Late osteoarthritis

22. SLIPPED CAPITALSLIPPED CAPITAL
FEMORAL EPIPHYSISFEMORAL EPIPHYSIS
A true adolescent problem

23. Gradual or acute slip
through the capital
femoral physis

24. SLIPPING

25. SLIPPED CAPITAL FEMORALSLIPPED CAPITAL FEMORAL
EPIPHYSISEPIPHYSIS
clinical profile pictureclinical profile picture

26. SCFE
Boys more than girls
Left more than right
Bilateral – 20 %

27. Etiology
Exact cause – unknown
Hormonal
Trauma
Mechanical factors

28. Classification
Preslip
Acute
Chronic
Acute on chronic

29. Preslip
Weakness or pain in the thigh or
knee
Limitation of internal rotation
X-ray – widening of the physis

31. Acute
 Less than 3 weeks duration
 Trauma – may be insignificant
 Bedridden – antalgic gait
 Shortening
 External rotation deformity
 Axis deviation

33. Acute on chronic
Mild trauma results in
increase in the prodromal
pain present for more than 3
weeks

34. Chronic
Intermittent pain present for
more than 3 weeks.

35. Investigations
X-ray – AP
Frog leg lateral view
( contraindicated when
suspecting acute slip)

36. Eyes
do not see
what mind
does not know
It is true
about reading
x-rays also

42. Goal of treatment
 Promote early physeal closure
 Prevent additional slipping
 Relieve pain
 Correct deformity
 Restore function of hip
 Prevent complications

43. Conservative management
Rest
Analgesics

44. Surgical treatment is the
standard

45. Surgical options
Insitu pinning
Reduction and fixation
Corrective osteotomies

46. Insitu pinning
Image intensifier control
Cannulated screw fixation

47. C-ARMC-ARM

52. Complications
Chondrolysis
Avascular necrosis
Secondary osteoarthritis

54. PERTHES DISEASE
Common problem
4 – 12 years of age
Male > female (4:1)
Low socioeconomic status

55. Late onset Perthes after
the age of 9 years.

56. Etiology
Exact etiology – unknown
Current theory – vascular
embarrassment
Increased intra-osseous
pressure

57. This results in avascular
necrosis of the capital
femoral epiphysis.

58. Clinical features
Painless limping

59. CLINICAL PROFILE
Abduction-Internal rotation
limited
Flexion variably limited
Adduction deformity
Limb-length discrepancy

60. INVESTIGATIONS
X-ray --- AP & FROG LEG
LATERAL
Sclerosis of the epiphysis
Collapse of the epiphysis
Subchondral fracture

61. MRI – to know the shape
of the cartilage
ARTHROGRAM

62. ARTHROGRAM

63. Subchondral fracture
heralds the onset of
clinical Perthes.

69. MANAGEMENT
Depends on stage of disease
Shape of the head
Management of complications

70. CATERALLCATERALL CLASSIFICATIONCLASSIFICATION
 Group I only ant. part of
epiphysis involved
 Group II ¼ to ½ involved
 Group III upto ¾ involved
head at risk sign
 Group IV whole epiphysis
sequestrated

71. Guiding principle in the
treatment is the
containment of the
femoral head in the
acetabulum.

72. Treatment options
Conservative
Surgical
Supervised neglect

73. In the initial synovitis stage
treatment is by skin
traction

74. Conservative treatment
Time consuming
Difficult for parents and child
Psychological problems

76. Surgical treatment
Contain head by osteotomies
Femoral or acetabular
Varus derotation osteotomy of
femur commonly done

77. VARUS DEROTATION
OSTEOTOMY
 Redistributes the
load on the femoral
head more
uniformly
 Relaxes the
muscles by
increasing the
functional length
of the femoral neck
 Enhances the
reciprocal
moulding of the
head-
BIOLOGICAL
PLASTICITY
 Improves blood
supply & healing

103. Complications
Hinged abduction
Chondrolysis
Secondary osteoarthritis

105. TB HIPTB HIP
Not so uncommon in our
practice
Family history of TB

106. TB HIPTB HIP
Limp – commonest presentation
Night cries
Stiffness
Wasting
Fever
Weight loss

107. TB HIPTB HIP
Raised ESR
Mantoux test
X-ray
PCR
IgM antibody assay
Biopsy

108. TB HIP- X-RAYTB HIP- X-RAY
 Osteoporosis
 Travelling acetabulum
 Dislocated hip
 Mortar and pestle appearance
 Perthes type
 Protrusio acetabuli
 Destruction of head

109. TB HIPTB HIP
 ATT
 Traction
 Splintage
 Surgery – last resort

110. IDIOPATHIC
CHONDROLYSIS

111. Progressive destruction
of articular cartilage with
effusion and joint space
narrowing.

112. Girls -- 9 – 18 years
Insidious onset
Pain
Limping
Stiffness

113. Investigations
X-ray -- joint space
narrowing
Blood – within normal limits
MRI

114. TREATMENT
NSAID’s
Aggressive physical therapy
(CPM)
Periodic traction
Bed rest
Prolonged non - weight bearing

115. Questions & Comments