There are several diseases that cause problems from the hip in children in the form of, for example, lameness, reduced joint mobility, snapping and cracking. Often it hurts the hip and sometimes also the thigh and knee.

It is important that the child is examined for a diagnosis and to be able to prevent any complications in time.

When and where should I seek care?

If it’s in a hurry

If a child has one or more of the symptoms of hip problems and at the same time has a fever or is unable to stand on his or her leg, contact a health care center or an on-call clinic immediately. If closed, seek care at an emergency room.

Hip inflammation – coxitis simplex

Coxitis simplex is an inflammation of the hip joint. The cause of the disease is not known, but often the child has had a cold before the hip problems begin.

Coxitis simplex occurs between the ages of two to twelve years but is most common in the five-to-six years of age. The disease is more common in boys.

symptoms of hip inflammation

It can hurt the hip, thigh and sometimes the knee.

Often, the child has had an infection before, such as a cold, or throat flux. But the most common thing is that the symptoms come without any infection before.

Investigations

During the examination, the doctor usually notices that the child has more or less difficulty moving the leg in the hip joint. The child usually gets blood tests if they have elevated body temperature. The doctor checks the blood tests to see if there is an infection. The child may have an x-ray and ultrasound examination if the docWor suspects that there may be other diseases.

Treatment of hip inflammation

The child needs rest and should preferably lie to bed. They can rest at home and stay still as much as possible if the symptoms are mild and the tests are normal. Otherwise, it may take longer before the trouble goes over.

The child can be hospitalized for observation if they are very sore and unable to support the leg, or have a fever.

In mild cases, the symptoms usually go away after two to three days of rest. Then the child may be more physically active, but should not go for long walks or participate in strenuous sports activities such as football or ice hockey.

At a new doctor’s visit, one to two weeks after the hip problems began, the ability to move in the hip joint is checked. If all is well, the child may be physically active. The doctor does supplementary examinations to be able to rule out other causes of the trouble if the child still has difficulty moving the leg in the hip joint.

Complications and sequelae

Coxitis simplex usually passes without any risk of complications in the future. For some children who once had the disease, the risk of having it again in infections is slightly greater.

Hip dysplasia

Hip joint dysplasia means that the hip joint of the hip, which the ball should guide, is not as deep as it should be. It is an unusual condition.

One reason may be that the child has a congenital unstable hip joint, which may prevent the joint from developing properly. But it is mostly unclear why hip dysplasia occurs.

Symptoms of hip dysplasia

The child limps and aches in the hip in connection with activities, for example when they are playing and running. Sometimes hip dysplasia is not detected until after four to six years of age.

Treatment of hip dysplasia

The appearance of the joint varies greatly in children up to the age of two, and it can be difficult for a doctor to determine on the radiograph whether the child has hip dysplasia or not. Because the treatment becomes more complicated and the result more uncertain the older the child becomes, children are always treated if the doctor suspects that the child has hip dysplasia. Untreated, it can cause joint damage.

First of all, the child usually gets a bandage to use at night. The bandage treatment ensures that the hip joint is held in place against the joint and stimulates the joint to grow and form properly. The doctor then examines the hip with regular x-ray examinations, approximately every six months. The frequency of hip replacement X-rays depends on the development of the joint and the age of the child. After three to four years of age, night bandages usually have no major effect. Then the doctor decides whether it is possible to wait and follow the continued spontaneous development, or if the hip joint needs surgery.

Slipping between hip and thigh – hip joint physiolysis

Between the hip joint and the femur, there is a growth zone of cartilage that contributes to the femur growing longitudinally. Just before and during puberty, the growth zone is weakened, which can cause a slip between the femur and the joint.

Hip arthritis is rare but more common in boys than girls. It is more common in children who are tall or overweight. Hip arthritis is very rare in those who have received menstruation.

Symptoms of hip joint physiolysis

The most common symptom is that the child limps or complains of pain in the groin area, the thigh or at the knee joint. Since the symptoms, in the beginning, tend to be quite mild and get stealthy, it can sometimes take a long time before it is detected. The few children who are really hurt have usually had a minor slip with mild symptoms first, and then the slip has suddenly worsened. It is unusual for the child to suddenly get so bad that they cannot support the leg.

Treatment of hip joint physiolysis

The doctor performs an operation and inserts screws or pins so that sliding cannot continue. Sometimes the other hip is also operated, as there is a risk of slipping on both sides.

Seek care at once if the baby starts to limp or get hurt even on the other side if that hip is not operated on.

After the surgery

Depending on how strong the slides have been, the child can either start going straight with the help of crutches or be in bed for one to two weeks. The position is checked with a new X-ray after the operation.

The child may walk with the help of crutches and sometimes strain the leg of the operated side. They can load the bones of the healthy side as usual if that side has been stabilized for preventive purposes.

The hip position is checked by x-ray after six to eight weeks. The child can walk without crutches and participate fully in activities if all is well. Thereafter, the hip joint is usually x-rayed every three or six months for one year. Both hip joints are usually x-rayed.

It then takes a couple of weeks before the wound has healed, but when the pain has subsided, the baby may be running as usual.

Complications and sequelae

Hip arthritis can cause some complications. For example, the blood supply to the joint head may be impaired. This, in turn, can cause the shape of the head to change and it becomes osteoarthritis. This means that the cartilage is unevenly loaded and broken down. The risk increases the greater the slip, but if the growth zone is stabilized early, the risk of osteoarthritis is very small.

Creaking or crunching hip joint

It is common to hear or feel small bangs or snaps from the hip or knee joints. It is completely harmless. There is usually no need for any special examination or cause for concern if the child has no other symptoms.

You do not have to worry about the hip joint to jump out of the joint. The squat is because the muscles at the outside of the thighs slide with one button over the outer part of the hip joint. This is most common in tall and thin girls in their teens. It usually does not hurt, although the button can be clearly heard. It is often possible to see how the muscle slides over the outer part of the hip. Some may induce the button with a will.

Treatment of creaking or crunching hip joint

It is possible to remove the pain if it hurts a lot and continues to hurt after the child has stopped growing. It is best to abstain for as long as possible as the clasps usually pass by themselves and it becomes a scar after the operation.

Impaired ability to move the leg outward in the hip joint – abduction restriction

Abduction restriction means that a child has difficulty moving the legs outward in the hip joint. Often it is discovered in a survey of, for example, BVC. It may be a sign of congenital hip dislocation, but it is more common than it is due to tightness in the muscles. The tightness can be caused by the child’s lying or crawling habits, for example, if the child is very much on one side.

Treatment of abduction restriction

Mobility usually gets better by itself if the child is in different positions, and on both sides.

In exceptional cases, the tightness may need to be corrected by extending the tendons in the groin. It is followed by bedtime and treatment in a so-called booklet stretch. Then the child may lie on his back in a bed with a special position that keeps his leg stable.

Perthes disease

In Perthes disease, the surface of the joint ball in the hip joint becomes uneven. The disease usually begins at three to nine years of age and is more common in boys than in girls. Perthes disease may be present in younger or older children as well, but it is uncommon. Sometimes the child can get the disease in both hip joints.

What is it?

The reason is probably that the blood supply to the hip joint head is deteriorating. As a result, the joint surface is softened and flattened.

Symptoms of Perthes disease

The child starts to limp and aches in the hip as they rest and walk, play, jump and run.

Investigations

Often the hip joints need to be x-rayed. In rare and unclear cases, other investigations may need to be done, such as a magnetic camera examination. A new examination and an X-ray may also be needed after a few months.

Treatment of Perthes disease

Once a child has been diagnosed with Perthes disease, they need to be careful with the hip and avoid those that hurt. For example, younger children should not go for long walks, but rather go for a trolley. Older children, for example, should not play football actively at the club level. However, swimming, cycling or riding usually go well and can be recommended to maintain mobility without stressing the trail too much.

Bedtime and rest at home may be necessary for the pain to go over if it hurts a lot. Otherwise, the child may be at preschool or attend school as usual. The staff needs to be informed about the child’s condition. The child should not participate in stressful activities in school gymnastics such as running, jumping and ball games. The child may need painkillers and anti-inflammatory drugs if the hip is very stiff and it hurts a lot.

Children who become very stiff in the hip can be treated with physical therapy, especially swimming pool training.

Operation

When the ball is flattened, there is a risk that it will eventually slip out of position. It will be more difficult for the joint to heal if it slides out of position in the hip.

In these cases, the child may need surgery. The procedure is performed under anesthesia and means that the femur is cut off just below the hip joint. Then the ball is angled in towards the boiler. The new position of the leg is fixed with a heavy screw that is connected to a plate that is attached to the femur with screws. The position afterward is checked by an x-ray.

The child may lie in bed for a few days. They can then come up and walk with the help of crutches but without supporting the leg. Younger children who are unable to walk with crutches and relieve the leg need much help and are moved with the help of a wheelchair. After six to eight weeks the leg has healed and the child can support the leg as usual. Thereafter, the child should be careful and not overload the leg.

About one year after surgery, the plate is removed.

How are you doing then?

In the first half of the year after the symptoms showed, the joint bead is compressed and softened more and more. Then comes a healing phase when the articular ball is calcified again and resumes some of its original forms. The chance that the head of the head retains or regains its normal shape is greater the younger the child is when the disease breaks out. The prognosis is slightly worse for girls, especially if they are older than seven years when the disease starts.

It usually takes two to three years from the onset of the disease to cure. In the vast majority of cases, the child may engage in any sport after healing. Discuss with your doctor what is right. Should the child have any symptoms, let them rest and spare the hip. Sometimes the child may have to forgo sports that are stressful to the hip, such as football.

The hip joint can be more sensitive to exertion during adolescence and thereafter. Those who have had a deformed joint are usually advised against work that is physically heavy, such as construction work, work in agriculture or chores that involve a lot of climbing on ladders or demands for mobility at all.

Complications and sequelae

The disease usually does not cause complications or concomitant diseases, but there is a risk of early osteoarthritis with pain, strain pain, lameness and impaired mobility. This may mean that the hip must be replaced with an artificial hip joint as early as the age of 45 to 50.

Ehtisham Nadeem

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