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Hip Complaints in Children and Adolescents

Perthes’ disease

Perthes’ disease afflicts children between the ages of 3 years and 11 years. Its precise cause is unknown. The bone structure of the head of the femur becomes deformed and flattened due to osteonecrosis (death of bone). The child complains of tiredness and of pain in the groin and sometimes the knee, and a limp is present. The diagnosis is made by X-ray examination, bone scan, and MRI. Depending on the severity of changes in the femoral head, the treatment varies from surgery to none at all. The healing process is prolonged. Although Perthes’ disease only affects the hip joint, pain is sometimes absent from that joint and is felt instead in the knee. Both joints should be X-rayed in cases of knee pain if Perthes’ disease is not to be
missed. Children with this condition usually have to avoid pounding activities.


Epiphysiolysis (slippage of the epiphysis at the neck of the femur) occasionally affects boys aged 11–16 years. Pain begins in the groin region, but as is usual in hip disorders, is also felt in the knee. It can be
triggered by sporting activity. It is important that young people who complain of this type of symptom should be X-rayed to exclude the possibility of slipped epiphysis. Surgery is usually needed.

Synovitis of the hip

Acute pains in the hip in children are usually caused by synovitis (inflammation of the tissues surrounding the joint). The pain increases with time, and the child shows an aversion to hip movements and sometimes has difficulty with walking—limping may be the result. Inflammation of the hip joint is seen mainly in children below the age of 10 years; it is considered to be a benign condition, which should be investigated by a specialist but which resolves spontaneously.
The hip disorders in children and adolescents described above should be distinguished from serious conditions such as bone infection (osteomyelitis), tuberculosis, rheumatic diseases, and tumors.

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