Radiologic evaluation of the hip in infants, children, and adolescents
- Cecilia Matilda Jude, MD
Cecilia Matilda Jude, MD
- Clinical Professor
- David Geffen School of Medicine at UCLA
- Shahla Modarresi, MD
Shahla Modarresi, MD
- Associate Clinical Professor
- David Geffen School of Medicine at UCLA
The hip is a stable, major weight-bearing joint with significant mobility. In children, common causes of hip pathology include developmental dysplasia of the hip (DDH), transient synovitis, septic arthritis, Legg-Calvé-Perthes disease, and slipped capital femoral epiphysis (SCFE). Less common hip disorders include proximal femoral focal deficiency, developmental coxa vara, neuromuscular hip dysplasia, injuries about the hip, arthritides, and tumors. The radiologic evaluation of common and less common hip disorders is discussed below.
Accurate diagnosis and treatment of pediatric hip disorders are important because of the potential complications, which may lead to degenerative joint disease in adult life. The history and physical examination, which are necessary to develop a differential diagnosis prior to the selection of imaging tests, and a general review of the imaging tests that are used in the evaluation of bone and joint pain, including the physical principles underlying their usefulness, are presented separately. (See "Overview of hip pain in childhood" and "Approach to the child with a limp" and "Imaging techniques for evaluation of the painful joint" and "Radiologic evaluation of the painful hip in adults".)
TYPES OF IMAGING STUDIES
The modalities available for evaluation of the hip include plain film radiography, ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), radionuclide bone scan, conventional arthrography, magnetic resonance (MR) arthrography, and CT arthrography (table 1).
●Plain film radiography – Plain film radiography is used in the initial evaluation of any cause of hip pain or limp. Because the appearance of a child's hips varies with age, strong consideration should be given to ordering anteroposterior (AP) and frog leg lateral views of the pelvis rather than views of a single hip . This allows easy comparison with a "control" hip in children with unilateral problems. The average radiation dose from pelvic radiographs is 0.5 mSv .
●US – US has low cost, is readily available, allows dynamic evaluation of the tendons and muscles, and does not involve ionizing radiation; however, it is highly operator dependent. In children, US may be useful in the following conditions:
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- TYPES OF IMAGING STUDIES
- IMAGING STUDIES FOR SPECIFIC CLINICAL SETTINGS
- - Developmental dysplasia of the hip
- - Proximal femoral focal deficiency
- Toddlers and children up to 10 years of age
- - Acute transient synovitis
- - Septic arthritis
- - Osteomyelitis
- - Developmental coxa vara
- - Legg-Calvé-Perthes disease
- - Neuromuscular hip dysplasia
- Children older than 10 years and adolescents
- - Slipped capital femoral epiphysis
- - Injuries about the hip in adolescents
- Pelvic apophyseal avulsions
- Iliopsoas tendinosis and bursitis
- Snapping hip syndrome
- Athletic pubalgia
- Stress fractures
- Acetabular labral tear
- Femoroacetabular impingement
- - Idiopathic chondrolysis of the hip
- Children of any age
- - Juvenile idiopathic arthritis
- - Tumors