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Pediatric Hip Pathology in Eastern India. A Cross-sectional Study on Types and Incidence
Abhishek Kumar1, Ritesh Runu1, Santosh Kumar1
1Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Insights
Perthes' disease, infective arthritis, and developmental dysplasia of the hip (DDH) are common pediatric hip conditions in Eastern India. Late diagnosis of DDH and septic arthritis indicates significant gaps in primary healthcare screening and referral systems.
Area of Science:
- Pediatric Orthopedics
- Musculoskeletal Disorders
- Public Health
Background:
- Hip disorders in children encompass a range of conditions with diverse etiologies, including developmental, infectious, and traumatic causes.
- Timely diagnosis and treatment are crucial to prevent long-term morbidity such as deformities, gait abnormalities, and chronic pain.
Purpose of the Study:
- To determine the incidence and spectrum of pediatric hip pathologies in Eastern India.
- To analyze demographic and clinical presentation patterns of these hip conditions.
Main Methods:
- A prospective, observational study was conducted over 18 months at a tertiary care center.
- 120 pediatric patients (<16 years) with hip pathology were included after screening 5,830 patients.
- Data included demographics, clinical presentation, and diagnoses based on clinical, radiological, and biochemical assessments.
Main Results:
- The overall incidence of hip pathology was 2.05%, with non-traumatic conditions being more prevalent (87%).
- The most common diagnoses were Perthes' disease (31.93%), infective arthritis (24.16%), and developmental dysplasia of the hip (DDH) (15.9%).
- Limp and pain were common symptoms, and a significant proportion of DDH and septic arthritis cases presented late.
Conclusions:
- Perthes' disease, infective arthritis, and DDH are the most frequent hip pathologies in this region.
- High rates of late presentations for DDH and septic arthritis highlight deficiencies in primary healthcare screening and referral.
- There is an urgent need for region-specific management protocols and enhanced public health awareness.
Introduction:
Hip disorders in children are a diverse group of conditions that may arise due to traumatic, developmental, infectious, neoplastic, metabolic, and miscellaneous causes. These pathologies can lead to significant morbidity if undiagnosed and not treated promptly, resulting in permanent deformities, gait abnormalities, chronic pain, and compromised quality of life.
Objectives:
The objective of the study was to determine the relative incidence and spectrum of various hip pathologies in pediatric patients (aged <16 years) presenting to a major tertiary care Center in Eastern India and to analyze the demographic and clinical presentation patterns.
Materials And Methods:
This study was approved by the Ethics Committee of Indira Gandhi Institute of Medical Sciences (IGIMS) PATNA (Ethics Code: 989/IEC/IGIMS/2023) on April 10, 2023. All participants provided written informed consent before enrolment in the study. This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. This was a prospective, observational, and non-randomized study conducted over 18 months at the Department of Orthopedics, IGIMS, Patna. A total of 120 patients with exclusive hip pathology were included after screening 5,830 pediatric patients. Data collected included demographics, clinical presentation (pain, limp, fever, etc.), and final diagnosis based on clinical, radiological, and biochemical assessments.
Results:
The overall incidence of hip pathology among children reporting to the Orthopedics department was 2.05% (120 out of 5830). Non-traumatic conditions (87%) significantly outnumbered traumatic conditions (13.34%). The most common diagnoses were: Perthes' disease (31.93%), followed by Infective Arthritis (24.16%) and developmental dysplasia of the hip (DDH) (15.9%). The highest frequency of cases was observed in the 5-11 years age group (44.53%) and in males (63%). Perthes' disease showed a strong male preponderance (84% males), while DDH was predominant in females (73.68%). Limp (70.83%) and pain (57.5%) were the most common presenting symptoms. A significant proportion of patients with DDH (68.4%) and Septic Arthritis (86.97%) presented late.
Conclusion:
Perthes' disease, infective arthritis, and DDH are the most prevalent hip pathologies in this region of Eastern India. The high rates of infective conditions and late presentations for both DDH and septic arthritis highlight critical gaps in early diagnosis, screening, and referral systems in the primary healthcare infrastructure. Region-specific management protocols and increased public health awareness are urgently needed.
