Differential diagnosis and management of hip pain in childhood.

Hip pain in children is always potentially serious. Different specialists see a different spectrum of hip diseases. Acute hip pain is usually referred to the surgeons, and the principal concern is to distinguish sepsis of the hip joint or pelvic bones from irritable hip: untreated sepsis can destroy the hip within days, but its presentation may be atypical or mild and investigations misleading. A reliable protocol for the management of acute hip pain in children is now available. Perthe's disease and slipped capital femoral epiphysis is usually evident on the initial radiograph. Hip disorders with a subacute or chronic presentation are usually referred to the paediatrician or rheumatologist. If examination shows restriction of hip movement or there are radiographic abnormalities, many will have a serious disorder requiring long-term management. The diagnosis is often apparent on the initial radiographs, although special imaging techniques may be needed. In a monoarticular presentation of juvenile arthritis, the hip radiograph will be normal but the diagnosis evident from other clinical features or blood investigations. Recognition of non-organic syndromes presenting with hip pain requires the exclusion of organic causes and an alertness to the incongruity of the physical signs.