Pain in the hip joint in children

When a child complains of pain in the knee joint, examine the hip joint.

Whether there is a fever at the child? If there is, urgently make a blood sowing + diagnostic arthrotomy to exclude septic arthritis (do not rely solely on aspiration of the hip joint).

Think about the slipping of the epiphysis of the femur in a teenager. If the child has unexplained painful lameness, then it is necessary to clinically and radiological examination of the hip joints. Usually in such cases the child should be hospitalized for observation and compliance with the appropriate treatment (+ traction). A survey is also conducted to exclude tuberculous lesions of the hip joint or Perthes disease. If the patient had a restriction of movements in one hip joint that spontaneously passed after several days of rest (on bed rest), and the radiologic picture of this joint is normal, retrospectively the diagnosis of transient synovitis of the hip joint (known as the irritated hip joint - "Irritable hip"). If there is a lesion of other joints, you should think about the diagnosis of juvenile rheumatoid arthritis.

Perthes disease. This is the osteochondritis of the head of the femur, affecting children aged 3 to 11 years (usually 4-7 years). In 10% of cases it is bilateral, in boys it is found 4 times more often than in girls. Perthes' disease is manifested by pain in the hip joint or in the knee and causes lameness. When examining a patient, all movements in the hip joint turn out to be painful. On the roentgenogram of the hip joint in the early stages of the disease, there is an enlargement of the joint between the joints. In later stages of the disease, the size of the core of the femoral head is reduced, its density becomes non-homogeneous. In even later stages, a collapse and deformation of the femoral head may occur, as well as a new bone formation. A sharp deformation of the femoral head is a risk factor for the early onset of arthritis. The younger the patient, the more favorable the prognosis. For mildly expressed forms of the disease (less than the lesion of the femoral head according to the lateral radiographs, and the total capacity of the joint cavity is preserved), treatment consists in observing the bed rest until the pain subsides. In the future, an x-ray is necessary. For people with a less favorable prognosis (1/2 of the femoral head is affected, the interarticular gap is narrowed), varous osteotomy can be recommended to guide the femoral head into the acetabulum.

Slipped upper epiphysis of the thigh. In men, this condition occurs 3 times more often than in women, with adolescents aged 10 to 16 suffering. In 20% of cases, the lesion is bilateral; 50% of patients suffer from overweight. This displacement occurs along the growth plate, while the epiphysis slides down and back. The disease is manifested by lameness, spontaneous pain in the groin and along the front surface of the thigh or knee. In the study of the patient, flexion, retraction and medial rotation were violated, in the position of the patient, the lying foot is rotated outward. The diagnosis is established by a lateral roentgenogram (the x-ray in the anterior projection can be normal). In untreated cases, avascular necrosis of the head of the femur is washed, possibly also an improper fusion of tissues, which has to develop arthritis. With a lesser degree of slippage, a bone nail can be used to prevent further slipping, and with severe degrees it requires complex reconstructive operations.

Tuberculous arthritis of the hip joint. At present, it is rare. Children who are 2-5 years old and elderly are more often ill. The main symptoms are pain and lameness. Any movements in the hip joint cause soreness and muscle spasm. The early radiographic evidence of the disease is the rarefaction of the bone. In the future, a slight unevenness of the joint margin and a narrowing of the joint between the joints develop. Even later, bone erosions can be detected on radiographs. It is important for such a patient to ask about contacts with patients with tuberculosis. It is necessary to determine ESR, perform chest X-ray and Mantoux reaction. The diagnosis can be confirmed by a sinus syncope. Treatment: rest and specific chemotherapy; Chimotherapy should be carried out by experienced medical staff. If significant destruction of the hip joint has already occurred, you may need arthrodesis.

[1], [2], [3]