What Are Hip Disorders?

Hip disorders can affect one or both hips and are sometimes apparent at birth. Scottish Rite for Children treats thousands of patients with hip disorders every year. Our physicians in the Center for Excellence in Hip conduct groundbreaking research to determine the best treatment plan for each patient with a hip condition.

Areas of Treatment

What Is Developmental Dysplasia of the Hip?

The hip joint consists of:
  • ​Femoral head: The ball part of the femur 
  • Acetabulum: The socket of the pelvic bone 
Developmental dysplasia of the hip (DDH) is a general term that refers to an abnormal relationship between the ball and socket of the hip joint in which there is an inadequate coverage of the ball by the socket or there is a dislocation of the ball from the socket (i.e., the ball is completely outside the socket). In some cases, the ball can slip in and out of the socket, which is referred to as a dislocatable hip or an unstable hip.

DDH can occur before birth, at birth, after birth or during early childhood. In most patients, the diagnosis of DDH is made during the first year of life with neonatal and perinatal exams followed by a hip ultrasound. Sometimes, the signs of DDH are subtle and go unnoticed until walking age or adolescence (adolescent hip dysplasia) when hip pain occurs.

The diagnosis of a dislocated or dislocatable hip in infants is often challenging as it is not painful and does not limit the physical development of the child, such as walking. It is important to identify DDH as early as possible and to treat this condition to prevent hip problems later in life.

The cause of DDH is unknown; however, it is more common in babies who are born in breech presentation (feet first). There also seems to be a genetic component associated with DDH because children with a family history of the condition are more likely to have DDH than those without a history of hip disease in the family. Swaddling of babies with legs straight also increases the risk.

The condition can be discovered by checking a baby’s hips and, if suspected, performing an ultrasound of the hip. Your baby’s doctor should look for:
  • A hip click
  • Limited hip movement
  • A difference in leg lengths
  • Increased skin folds on thighs
  • When both hips are dislocated, the leg lengths, skin folds and hip movement are going to be the same, which makes the diagnosis difficult without getting an ultrasound or X-ray
  • If the child walks, a waddling or swayed-back walking pattern

DDH treatment depends on the child’s age, the results of the hip exam and the results of the ultrasound or X-ray. Observation may be necessary, or more active treatment options may be recommended. These options may include the use of a Pavlik Harness as well as surgery with or without traction if nonsurgical treatments are unsuccessful. Depending on the patient and the severity of the condition, your doctor will discuss all options if surgery is necessary.

Nonsurgical Treatment Methods
  • Observation: The doctor may want to watch the child’s hips closely if the hip exam shows a stable hip. Sometimes babies’ hips are loose at birth but not dislocatable, and they may tighten on their own after a few weeks.
  • Pavlik Harness: For babies less than six months of age, the doctor may recommend a soft, fabric brace called a Pavlik Harness. The Pavlik Harness keeps the hips in a “frog-leg” position, holding the ball of the thighbone in the hip socket. The harness is usually worn for 23 to 24 hours per day for a few weeks, followed by a period of weaning off the brace for another few weeks. For 95 percent of babies treated with a Pavlik Harness, no further treatment is ever needed.
What Is Adolescent Hip Dysplasia?

Hip dysplasia, often seen in preschool to middle school-aged children, is an abnormal formation of the hip that predisposes the ball of the thighbone to slip in and out of the socket. The condition occurs at birth or in early childhood, but it can persist through adolescence if the diagnosis is not treated or if the child’s symptoms go unnoticed.

Hip pain in a child’s adolescent years may be the first symptom of hip dysplasia. Your doctor can confirm the condition by taking an X-ray of the child’s hip. The X-ray will reveal a hip socket that does not completely “cover” the top of the ball part of the hip and is too shallow. This leads to pain because the ball part of the hip is not fitting properly into the socket.

Nonsurgical treatment options for adolescent hip dysplasia include physical therapy, activity restriction and weight loss. If the condition is wearing down the hip, surgery is an option. The goal of surgery is to alleviate pain and allow the child to return to an active lifestyle.
What Is Perthes Disease?

Perthes disease, also known as Legg-Calvé-Perthes disease, is a childhood hip disorder that primarily affects the ball part of the hip joint. This ball is called the femoral head and sits on top of the femur, which is the long bone of the thigh. The femoral head is normally round and fits inside the round socket of the pelvis, called the acetabulum.
In Perthes disease, the blood supply to the femoral head is disrupted and all or part of the femoral head dies from the lack of blood flow. This death of the bone cells is called “avascular necrosis” or “osteonecrosis” of the femoral head. The femoral head is less strong after the bone dies and can become flattened due to weight and pressure placed on the bone during normal physical activity. Over a one- to two-year period, the damaged bone in the femoral head is slowly removed and replaced with new bone.

To learn more about the medical terms associated with Perthes disease, please view our glossary of terms.

The cause of Perthes disease is currently unknown. Perthes disease is not considered to be inherited since less than 5 percent of children with Perthes disease have a family history of the disease. There are hip conditions that are inherited that can mimic Perthes disease, such as multiple epiphyseal dysplasia and other skeletal dysplasia.

Perthes disease is a disease of exclusion, which means that because there are other conditions that can mimic Perthes disease, similar conditions must be ruled out by taking a careful medical history and doing a thorough physical examination. Physicians generally ask about family history of hip disorders, family history of early joint replacement, previous hip surgery, past use of steroid medication for asthma or other medical conditions, history of sickle cell disease, history of hip infection, clotting disorders and endocrine disorders. 

In addition to medical history and physical examination, X-rays of the hips are required to make the diagnosis of Perthes. In a small number of patients who come to the clinic shortly after the onset of symptoms, the X-rays may be normal if not enough time has passed for changes to occur. If the patient is still suspected of having Perthes disease, a perfusion MRI may be helpful to make the diagnosis, as it is more sensitive than conventional MRI.

Various treatment methods exist for Perthes disease, and the best treatment option depends on several factors, such as the age of the child at onset of the disease, the amount of femoral head involvement and the stage of the disease at diagnosis. Because of these factors, plus the child’s ability to comply with treatment instructions and a doctor’s findings during examination, treatment is individualized. No single treatment method will work for all patients, and no single treatment consistently prevents the development of femoral head deformity. 

The primary goals of treatment for Perthes disease are to alleviate pain and to prevent lasting deformity of the femoral head. Because it is easier to prevent or minimize femoral head deformity than to restore the round shape of the femoral head after it has flattened or collapsed, early institution of treatment is important for older patients (8+ years) who do not have good femoral head reshaping potential. Treatments that restore hip motion and help reshape the femoral head as best as possible are used when the child is diagnosed at a later stage of the disease. 

To learn more about Perthes, please view the Perthes disease FAQs.​
What Is Slipped Capital Femoral Epiphysis?

Slipped capital femoral epiphysis (SCFE) usually occurs during the teenage years when the thighbone is growing at a fast rate. The condition causes the ball part of the child’s thighbone (capital epiphysis) to slip from the growth plate, causing the child to limp or feel pain in the thigh or knee.

The cause is unknown, but the condition may be linked to several factors:
  • Weakness in the bone due to hormone abnormalities (i.e., low thyroid hormone)
  • Excessive weight
  • Family history of hip conditions

The child’s doctor can confirm SCFE by taking an X-ray of the hip. The pain from this condition can be in the hip, thigh or knee area. There are two types of SCFE: 
  • A slow slipping of the epiphysis (stable SCFE) 
  • A sudden slipping of the ball part of the hip, resulting in severe pain and inability to walk (unstable SCFE)

If your doctor suspects SCFE, the child should stop walking and be placed in a wheelchair (not crutches) to help prevent further slipping or a sudden slip of the bone. This can cause the ball part of the hip to die (avascular necrosis), resulting in long-term pain, limping or hip replacement surgery in early adulthood.

When SCFE is confirmed, the child will be admitted to the hospital and put on bed rest. One of two types of surgery is performed.
  • In Situ Pinning Surgery: This less-invasive surgery keeps the ball of the thighbone (capital epiphysis) from slipping further and secures it in the current position (in situ). One or two screws are placed through the skin into the thighbone to hold the epiphysis to the top of the thighbone and prevent further slipping.
  • Open Reduction Surgery: This surgical procedure is used for patients with unstable SCFE to align the bone within the hip socket and prevent loss of blood flow to the ball of the thighbone.
What Is Femoroacetabular Impingement? 

Femoroacetabular impingement (FAI) occurs when there is abnormal contact between the ball and the socket of the hip, causing pain and a decreased range of motion.

FAI occurs when the ball of the hip impinges against the rim of the socket inside the hip joint. This can happen from the ball being slightly misshapen, the socket being too deep or a combination of both.

Your doctor can confirm FAI by analyzing your family’s medical history, performing a physical exam and/or diagnostic testing (X-ray, MRI, CT scan). FAI can cause pain in the groin and on the outside, back or lower side of the hip or thigh.

  • Physical therapy with modified activities
  • Rest
  • Injection of numbing medication inside the joint
  • Surgery, if necessary, to trim away the areas that are impinging

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