Pediatric hip disorders

Developmental dysplasia of the hip includes a spectrum of abnormality in the developing femoral head and acetabulum. Universal ultrasonographic screening is performed in many countries, but not in the United States, where physical examination combined with risk factors serve as the indication for imaging. Treatment is aimed at promoting mutual concentric development of the femoral head and acetabulum and can be achieved with surgical and nonsurgical means. Legg-Calvé-Perthes disease is an idiopathic osteonecrosis of the femoral head. Current research is focused on earlier recognition of hip involvement, and treatment is focused on the principles of hip containment, whenever possible, and salvage procedures, when impossible. Slipped capital femoral epiphysis involves the displacement of the proximal femoral epiphysis in older children and adolescents, and may be affected by multiple anatomic, endocrinologic, and patient factors. Treatment involves the stabilization of the epiphysis to prevent further slippage. Early correction of proximal femoral deformity, particularly in unstable slips, is often advocated.