Significance of Hip Exams in School-Age Children

Key Hip Conditions and Examination Techniques

Hip exams in school-age children are essential for detecting developmental dysplasia of the hip (DDH), Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, and other conditions that can lead to early degenerative joint disease and lifelong disability if not identified and treated promptly, as recommended by the American College of Radiology 1, 2
The American Academy of Pediatrics recommends hip examination at every well-baby visit, continuing through childhood, with physical examination remaining the most important screening method, having a sensitivity of 85-90% and specificity of 90-95% 2
Limited hip abduction is a more useful clinical sign in children older than 3 months, as Barlow and Ortolani tests become less reliable with age, according to the Journal of the American College of Radiology 4
Asymmetric thigh folds are an important sign in older infants and toddlers indicating possible hip pathology, as noted by the Journal of the American College of Radiology 4
Gait assessment is critical in school-age children, as limping, waddling gait, or toe-walking may indicate hip pathology, as reported by the Journal of the American College of Radiology 4

Under 4 months, ultrasound is the preferred imaging modality for suspected DDH, as recommended by the Journal of the American College of Radiology and the American College of Radiology 1, 2
From 4-6 months and older, radiography becomes more reliable as ossification progresses, with the acetabular index being the most commonly used measurement, according to the American College of Radiology 2, 3

Late presentation of hip disorders is a major negative prognostic factor requiring more complex treatment and surgical intervention, as noted by the American College of Radiology 2, 5
Delayed diagnosis can lead to early degenerative joint disease and impaired function, highlighting the importance of regular hip examinations, as reported by the Journal of the American College of Radiology 4