ULTRASOUND IN THE MANAGEMENT OF THE IRRITABLE HIPS IN CHILDRENS. DOES IT HELP?

Abstract

Purpose: The aim of the study was to assess the usefulness of ultrasound in the management of Irritable hips in children’s.

Materials and Methods: Retrospective analysis was performed for 168 patients with irritable hip from January 2004 to December 2005. The right hip was affected in 86 patients and the left hip was affected in 85 patients. Bilateral hip affection was seen in 3 patients. All the patients presented with pain in the hip joint. Most had pain on internal rotation. Majority had limp lasting 0 – 3 days. All patients were older than 1 year. White Blood Cell count (WBC), C-Reactive Protein (CRP) and Ultrasound of the hip was performed on all the patients as per the Irritable hip protocol. Temperature and associated medical condition were also recorded. Patients were divided into two groups, Group A who could weight bear involved 146 patients and Group B who could not weight bear had 22 patients.

Results: Ultrasound examination showed no effusion in 77 patients in Group A and 11 patients in Group B. Remainder of patients in both the groups had hip joint effusion ranging from 2mm – 7mm. All the patients were treated conservatively. None needed aspirations of the effusion in the hip joint or secondary operative procedure.

In group A (Weight bearing patients), 30 patients had mild temperature and 1 had moderate temperature. All of these 31 patients had normal WBC, CRP and their ultrasound showed effusion from 0 – 7mm. 12/31 patients had URTI.

In group B (Non weight bearing patients), 5 patients had mild temperature with normal WBC, CRP and their ultrasound showed effusion from 0 – 6 mm. 1/5 patient had URTI.

All the remaining 115 patients in group A and 17 patients in group B had normal WBC and CRP values.

No associated medical problems were found in 102 patients in group A and 12 patients in group B. Upper respiratory tract infection was noted in 40 patients in group A and 9 patients in group B. Gastroenteritis was noted in 4 patients in group A and 1 patient in group B.

Conclusion: Questions are raised with regards to the role of ultrasound in management of Irritable hips. Ultrasound for irritable hips in weight bearing patients with normal WBC and CRP is of no help. Ultrasound may be considered for non-weight bearing patients despite normal parameters.

Significance: Ultrasound is not of much help in management of irritable hip with normal WBC and CRP. Ultrasound is of definite value to surgeon before any operative procedure for the hip joint.