• Hip disorder

• results from partial interruption of blood supply to immature femoral head

• cause unknown

• children 4-8yo

• boys>>girls (4:1)

• Increased incidence in:

• low birth weight

• abnromal birth presentation

• fhx

• higher birth order

• lower socioeconomic status

Presentation

• hip pain

• usually unilateral

• atraumatic limp

• referred pain in knee

Examination

• Limited hip abduction

• internal rotation

• leg-length discrepancy

Investigations

• AP and frog-leg lateral radiographs

• varying degrees of:

  • flattening

  • fragmentation

  • sclerosis

  • of prox femur growth centre with joint space widening

DDx

• Septic arthritis

• osteomyelitis

• SUFE

• Irritable hip

Poor prognostic factors:

• age >6yo at onset

• greater extent of femoral head deformity

• hip joint inconfuity

• dec. hip ROM

Treatment

• ortho referral - exclude septic arthritis [bloods]

• arthroscopic chondroplasty and loose body excision has shown good short-term results

• rest

• analgesia

• Usually resolves: Return to sport is possible when symptom-free and XR shown some improvement