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Radiologic evaluation of the hip in infants, children, and adolescents

Cecilia Matilda Jude, MD
Shahla Modarresi, MD
Section Editor
William Phillips, MD
Deputy Editor
Mary M Torchia, MD


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 "Approach to hip pain in childhood" and "Approach to the child with a limp" and "Imaging techniques for evaluation of the painful joint" and "Imaging evaluation of the painful hip in adults".)


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 [1]. This allows easy comparison with a "control" hip in children with unilateral problems. The average radiation dose from pelvic radiographs is 0.5 mSv [2].

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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Literature review current through: Nov 2017. | This topic last updated: Jul 31, 2017.
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