hip

• Legg-Calve Perthes


  Avascular necrosis of hip in childhood
• Epidemiology of Legg-Calve Perthes

  • M, 2-10yo
  • Small for age
  • 10% bilateral
• Etiology of Legg-Calve Perthes

  • Idiopathic
  • Trauma
  • Steroids
  • Sickle cell anemia
• Anatomy of Legg-Calve Perthes

  • Reossification and remodeling occurs which leads to flattening of the femoral head
• Clinical presentation of Legg-Calve Perthes

  • Hip/groin/knee pain
  • Painless intermittent limp that becomes painful
  • Pain in hip is worse with activity
• Physical exam of Legg-Calve Perthes

  • Small for age
  • Atrophy of proximal thigh
  • Hip stiffness and limited ROM
  • Decreased hip abduction/internal rotation
• Radiologic studies for Legg-Calve Perthes

  • X-ray
  • MRI
  • Bone scan
• Adult avascular necrosis


  Osteonecrosis, aseptic necrosis, bone infarction, ischemic necrosis
• Epidemiology of adult avascular necrosis

  • 30-70yo
  • Female
  • 50% bilateral
• Etiology of adult avascular necrosis

  • Idiopathic
  • Trauma
  • Excessive overuse
  • Sickle cell anemia
  • High corticosteroid use
• Anatomy of adult avascular necrosis


  • Necrosis of hip
• Hip dysplasia (DDH)


  Hip is dislocated from socket on ultrasound
• Epidemiology of hip dysplasia

  • Newborns
  • Females
• Etiology of hip dysplasia

  • Family history
  • Female fanny first (breech)
  • Firstborn
• Clinical presentation of hip dysplasia

  • Asymmetry
  • Hip click
  • Limited ROM
  • Unequal folds on one leg
• Slipped capital femoral epiphysis

  Epiphysis and diaphysis of femur have slipped out of their normal position. Looks like ice cream falling off a cone.
• Epidemiology/etiology of slipped capital femoral epiphysis

  • Obesity
  • Male
  • Left hip
  • 25-50% bilateral
• Clinical presentation of slipped capital femoral epiphysis

  • Groin pain
  • Limp/waddling gait
  • Thigh atrophy
  • Decreased ROM
• Physical exam of slipped capital femoral epiphysis

  • Drehmann sign (in supine, hip externally rotates and abducts with passive hip flexion)
  • Antalgic/waddling gait
  • Externally rotated leg on affected side
  • Can't bear weight
  • Limited ROM of hip
• Radiologic studies for slipped capital femoral epiphysis

  • X-ray of anteroposterior and frog-leg lateral
  • Widening of joint space
  • Decreased epiphyseal height
  • "Steel sign" (2x density from superimposition of epiphysis/metaphysis)
  • "Klein line" where hip does not line up with femoral head
• Hip fracture


  Fracture on hip bone
• Etiology/risk factors for hip fracture

  • Fall
  • Cancer
  • Chronic kidney disease
  • Prolonged steroid use
  • Osteoporosis
• Clinical presentation of hip fracture

  • Patient in pain, immobile, huge risk for increased mortality
• Physical exam of hip fracture

  • Short, externally rotated hip fracture, can't bear weight
• Etiology/risk factors for acetabular labrum tear and femoral acetabular impingement

  • Femoral acetabular impingement
  • Unknown
  • Excessive force
  • Hip dislocation/dysplasia
  • Repetitive microtrauma
• Clinical presentation of acetabular labrum tear and femoral acetabular impingement

  • Hip/groin pain
  • Catch/lock/click
  • Worse with activity like twisting/pivoting
• Physical exam of acetabular labrum tear and femoral acetabular impingement


  • FABER (flex, ab, ext rotate) non specific but indicates pain is in joint
  • Anterior impingement test
  • Scour test
• Etiology/risk factors for trochanteric bursitis

  • Trauma
  • IT band irritation
  • Weak abductor muscles
  • Gluteal tendons rubbing
• Clinical presentation of trochanteric bursitis

  • Lateral hip pain
  • Worse with walking/lying on that side
  • Pain with abduction of hip with full passive/active ROM
• Ortolani's test relocates the dislocation from Barlow's test and a positive is if a "clunk" is heard
• Barlow's test is adducting the hip while applying light pressure on the knee
• Developmental hip dysplasia patients can get a cast or a Pavlik harness before 6 months of age
• For slipped capital femoral epiphysis, avoid moving/rotating the leg, make the patient non-weight bearing, and urgently refer to orthopedics
• With a hip dislocation, the limb is shortened, adducted, and internally rotated with the hip and knee in slight flexion for a posterior dislocation, and the leg is externally rotated, abducted and extended at the hip for an anterior dislocation
• The anterior impingement test is positive if it elicits pain. It is performed by flexing the hip to 90 degrees, adducting the thigh, and internally rotating the hip
• A femoral head/neck fracture can be intracapsular (due to necrosis/lack of oxygen supply) or intertrochanteric where the fracture runs through the greater trochanter