If your child suddenly cannot bear weight or has severe hip pain with fever, go to hospital today. Infection in a child's hip joint is an emergency requiring urgent drainage. A sudden inability to walk in an adolescent may be a slipped growth plate needing immediate treatment.
Three childhood hip conditions that share one feature: treated early they usually do well, and left late they lead to hip replacement in early adulthood.
Written for parents. The most important message is about timing — in all three conditions the window for simpler, more effective treatment is measured in months, and it closes.
Developmental dysplasia of the hip means the socket is too shallow to hold the ball securely, so the hip is unstable or dislocated. It is present from birth or develops in infancy. Caught in the first months it is often treated with a simple harness that holds the hip in position while the socket develops normally. Caught at walking age it usually needs surgery, and caught in adolescence it may already have caused irreversible damage.
Perthes disease is a temporary loss of blood supply to the ball of the hip in a child, typically between four and eight years old. The bone softens, may deform under load, and then gradually reconstitutes over two to four years. The aim of treatment is to keep the ball properly contained within the socket while it heals, so that it reforms in a round shape rather than a flattened one.
Slipped upper femoral epiphysis occurs in adolescents, usually overweight, when the growth plate at the top of the femur gives way and the ball slips off the neck. It presents with hip or knee pain and a limp, and it is urgent — a stable slip can become an unstable one, which carries a high risk of the ball losing its blood supply.
A recurring theme runs through all three: knee pain in a child may be coming from the hip. Any child limping or complaining of knee pain without a clear injury deserves hip examination and, usually, a hip X-ray.
Pain from the hip is frequently felt in the knee in children, and this is one of the commonest reasons these conditions are diagnosed late. A child with knee pain and no injury, or with an unexplained limp, should have their hips examined and usually X-rayed. In adolescents this is particularly important, because a slipped growth plate presenting as knee pain can progress from a stable to an unstable slip while it is being investigated as a knee problem.
Which test depends entirely on the child's age.
Age determines what is possible more than almost anything else in paediatric hip conditions. A treatment that works well at eighteen months may be inappropriate at six years. Send a pelvis X-ray showing both hips for comparison, your child's date of birth, and a description of the limp — when it started, whether it is getting worse, and whether your child complains of pain in the hip, the thigh or the knee.
Treatment differs entirely between the three conditions and with the child's age.
A Pavlik harness holds the hips in a flexed, spread position so the ball sits properly in the socket and the socket develops around it. Worn for several weeks to months with regular ultrasound monitoring. Highly effective when started in the first months of life, which is why newborn screening matters so much.
The hip is relocated, either without opening the joint or by open surgery, and held in a plaster cast. In older children the pelvis or the femur may need to be cut and reshaped to provide adequate cover. Recovery involves several weeks in a cast and a period of restricted activity afterwards.
The aim is to keep the softened femoral head properly seated within the socket while it heals, so it reforms in a spherical shape. In younger children with good movement, observation, physiotherapy and restricted impact activity may suffice. In older children or where containment is poor, an osteotomy of the femur or pelvis redirects the head into the socket.
A screw is passed across the growth plate to stabilise it and prevent further slipping. It is done urgently, and the opposite hip is often fixed at the same time because the condition frequently affects both. Unstable slips carry a significant risk of the head losing its blood supply, which is why speed matters.
The same X-ray finding calls for entirely different treatment at six months, six years and sixteen years. Age drives the plan.
This determines whether containment surgery is likely to help or whether observation is reasonable.
A stable slip is urgent; an unstable one is an emergency with a high risk to the blood supply.
Paediatric hip surgery needs a surgeon who does it regularly and a hospital with paediatric anaesthesia and nursing. We verify both, and we will say if a case is better managed at a specialist centre than at a large general hospital.
A slipped growth plate and an infected hip are both local emergencies. Send us the imaging afterwards and we will plan what comes next.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
It is important but very treatable when caught early. A Pavlik harness worn in the first months of life corrects the great majority of cases without any surgery, because the socket develops normally once the ball is held in the right position. The key is starting promptly and attending the monitoring ultrasounds.
It is worth having the hip examined. Hip pain is commonly felt in the knee in children, and this referred pain is a frequent reason hip conditions are diagnosed late. A child with knee pain and no injury, or an unexplained limp, should have their hips examined and usually X-rayed — including a frog lateral view in an adolescent.
It varies with the age at onset and how much of the femoral head is affected. Younger children generally do better because they have more growth remaining to remodel the hip. The aim of treatment is a round, well-contained femoral head at the end of the healing process, because a flattened one leads to arthritis in early adulthood. The condition itself is self-limiting over two to four years.
Yes, and it is frequently underestimated. A stable slip can become unstable, and an unstable slip carries a substantial risk that the ball loses its blood supply — which leads to permanent damage. An adolescent with hip or knee pain and a limp needs prompt X-rays including a frog lateral view, and confirmed slips are fixed urgently.
In a slipped growth plate, frequently — which is why many surgeons fix the opposite hip preventively at the same operation. In dysplasia, both hips are affected in a proportion of cases. In Perthes, involvement of the second hip is less common but does occur. This is why imaging should always show both hips.
It depends on how well the hip is restored now. A well-treated dysplastic hip in infancy usually functions normally for life. A Perthes hip that heals with a round, contained head generally does well. Hips left deformed — through late diagnosis or incomplete treatment — commonly develop arthritis in early adulthood. This is precisely why early treatment matters so much.
Send an X-ray of the pelvis showing both hips, your child's exact date of birth, and a description of the limp. Age determines what is possible more than anything else.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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