Semin Musculoskelet Radiol 2024; 28(04): 447-461
DOI: 10.1055/s-0044-1786153
Review Article

Imaging of Disease and Normal Variant Patterns in Pediatric Hips

Jade A. Anderson
1   Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
,
Nicholas Laucis
1   Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
,
John Symanski
1   Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
,
Donna Blankenbaker
1   Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
› Author Affiliations

Abstract

The pediatric hip undergoes significant changes from infancy through adolescence. Proper maturation is crucial for the development of a stable and functional hip joint. Imaging interpretation of the pediatric hip requires distinguishing normal variants and maturation patterns from pathology. We review femoral ossification centers, variants, and conditions that affect the proximal femur, such as Legg-Calvé-Perthes disease; the acetabulum, such as developmental hip dysplasia; the acetabular labrum, such as femoroacetabular impingement; and synovial pathology in children through adolescence. Understanding the spectrum of hip conditions and using advanced imaging techniques are essential for the accurate diagnosis and effective management of pediatric hip disorders.



Publication History

Article published online:
29 July 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Harcke HT, Lee MS, Sinning L, Clarke NM, Borns PF, MacEwen GD. Ossification center of the infant hip: sonographic and radiographic correlation. AJR Am J Roentgenol 1986; 147 (02) 317-321
  • 2 Bedoya MA, Chauvin NA, Jaramillo D, Davidson R, Horn BD, Ho-Fung V. Common patterns of congenital lower extremity shortening: diagnosis, classification, and follow-up. Radiographics 2015; 35 (04) 1191-1207
  • 3 Maes C, Kronenberg HM. Bone development and remodeling. In: Robertson RP. ed. DeGroot's Endocrinology. 8th ed.. Philadelphia, PA: Elsevier; 2023: 869-888
  • 4 Nguyen JC, Markhardt BK, Merrow AC, Dwek JR. Imaging of pediatric growth plate disturbances. Radiographics 2017; 37 (06) 1791-1812
  • 5 Butler P, Mitchell A, Healy JC. eds. Applied Radiological Anatomy. 2nd ed.. Cambridge, UK: Cambridge University Press; 2012
  • 6 Agrawal U, Tiwari V. Congenital Femoral Deficiency. StatPearls Publishing; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK580544/ Accessed April 1, 2024
  • 7 Zucker EJ, Lee EY, Restrepo R, Eisenberg RL. Hip disorders in children. AJR Am J Roentgenol 2013; 201 (06) W776-W796
  • 8 Uduma FU, Dim EM, Njeze NR. Proximal femoral focal deficiency - a rare congenital entity: two case reports and a review of the literature. J Med Case Rep 2020; 14 (01) 27
  • 9 Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011; 2011: 238607
  • 10 Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E. Legg-Calvé-Perthes disease overview. Orphanet J Rare Dis 2022; 17 (01) 125
  • 11 Mills S, Burroughs KE. Legg-Calve-Perthes Disease. StatPearls Publishing; 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK513230/ Accessed April 1, 2024.
  • 12 Sansgiri RK, Neel MD, Soto-Fourier M, Kaste SC. Unique MRI findings as an early predictor of osteonecrosis in pediatric acute lymphoblastic leukemia. AJR Am J Roentgenol 2012; 198 (05) W432-439
  • 13 Dillman JR, Hernandez RJ. MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol 2009; 193 (05) 1394-1407
  • 14 Scherl SA. Common lower extremity problems in children. Pediatr Rev 2004; 25 (02) 52-62
  • 15 Welton KL, Kraeutler MJ, Garabekyan T, Mei-Dan O. Radiographic parameters of adult hip dysplasia. Orthop J Sports Med 2023; 11 (02) 23 259671231152868
  • 16 Van Geel P, Cools W, Laumen A. Evolution of head-shaft angle and neck-shaft angle in childhood. Acta Orthop Belg 2021; 87 (03) 435-441
  • 17 Beals RK. Coxa vara in childhood: evaluation and management. J Am Acad Orthop Surg 1998; 6 (02) 93-99
  • 18 Lehmann CL, Arons RR, Loder RT, Vitale MG. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop 2006; 26 (03) 286-290
  • 19 Gholve PA, Cameron DB, Millis MB. Slipped capital femoral epiphysis update. Curr Opin Pediatr 2009; 21 (01) 39-45
  • 20 Herring JA. Tachdjian's Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children. 5th ed.. Philadelphia, PA: Saunders; 2013
  • 21 Hesper T, Zilkens C, Bittersohl B, Krauspe R. Imaging modalities in patients with slipped capital femoral epiphysis. J Child Orthop 2017; 11 (02) 99-106
  • 22 Bomer J, Klerx-Melis F, Holscher HC. Painful paediatric hip: frog-leg lateral view only!. Eur Radiol 2014; 24 (03) 703-708
  • 23 Balch Samora J, Adler B, Druhan S. et al. MRI in idiopathic, stable, slipped capital femoral epiphysis: evaluation of contralateral pre-slip. J Child Orthop 2018; 12 (05) 454-460
  • 24 Young SW, Safran MR. Greater trochanter apophysitis in the adolescent athlete. Clin J Sport Med 2015; 25 (03) e57-e58
  • 25 Bateni C, Bindra J, Haus B. MRI of sports injuries in children and adolescents: what's different from adults. Curr Radiol Rep 2014; 2 (05) 45
  • 26 Yagdiran A, Zarghooni K, Semler JO, Eysel P. Hip pain in children. Dtsch Arztebl Int 2020; 117 (05) 72-82
  • 27 Patel H. Canadian Task Force on Preventive Health Care. Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ 2001; 164 (12) 1669-1677
  • 28 Liu D, Mou X, Yu G. et al. The feasibility of ultrasound Graf method in screening infants and young children with congenital hip dysplasia and follow-up of treatment effect. Transl Pediatr 2021; 10 (05) 1333-1339
  • 29 Lee CB, Mata-Fink A, Millis MB, Kim Y-J. Demographic differences in adolescent-diagnosed and adult-diagnosed acetabular dysplasia compared with infantile developmental dysplasia of the hip. J Pediatr Orthop 2013; 33 (02) 107-111
  • 30 Beltran LS, Rosenberg ZS, Mayo JD. et al. Imaging evaluation of developmental hip dysplasia in the young adult. AJR Am J Roentgenol 2013; 200 (05) 1077-1088
  • 31 Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years?. World J Orthop 2015; 6 (11) 886-901
  • 32 Blankenbaker DG, De Smet AA, Keene JS, Fine JP. Classification and localization of acetabular labral tears. Skeletal Radiol 2007; 36 (05) 391-397
  • 33 Dietrich TJ, Suter A, Pfirrmann CWA, Dora C, Fucentese SF, Zanetti M. Supraacetabular fossa (pseudodefect of acetabular cartilage): frequency at MR arthrography and comparison of findings at MR arthrography and arthroscopy. Radiology 2012; 263 (02) 484-491
  • 34 Vaeth D, Dietrich TJ, Wildermuth S. et al. Age dependent prevalence of the supraacetabular fossa in children, adolescents and young adults. Insights Imaging 2022; 13 (01) 91
  • 35 DuBois DF, Omar IM. MR imaging of the hip: normal anatomic variants and imaging pitfalls. Magn Reson Imaging Clin N Am 2010; 18 (04) 663-674
  • 36 Safran MR, Money AJ, Vaughn ZD. et al. Acetabular rim ossification variants are found in almost 20% of patients presenting with hip pain. Arthrosc Sports Med Rehabil 2023; 5 (04) 100742
  • 37 DeFroda SF, Wichman D, Browning R, Alter TD, Nho SJ. Arthroscopic fixation of os acetabuli and labral repair: suture-on-screw technique. Arthrosc Tech 2021; 10 (06) e1491-e1496
  • 38 Savoye-Laurens T, Verdier N, Wettstein M, Baulot E, Gédouin J-E, Martz P. Labral tears in hip dysplasia and femoroacetabular impingement: a systematic review. Orthop Traumatol Surg Res 2023; 109 (04) 103539
  • 39 Nguyen MS, Kheyfits V, Giordano BD, Dieudonne G, Monu JUV. Hip anatomic variants that may mimic abnormalities at MRI: labral variants. AJR Am J Roentgenol 2013; 201 (03) W394-W400
  • 40 Lecouvet FE, Vande Berg BC, Malghem J. et al. MR imaging of the acetabular labrum: variations in 200 asymptomatic hips. AJR Am J Roentgenol 1996; 167 (04) 1025-1028
  • 41 Narvani AA, Tsiridis E, Kendall S, Chaudhuri R, Thomas P. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc 2003; 11 (06) 403-408
  • 42 Chopra A, Grainger AJ, Dube B. et al. Comparative reliability and diagnostic performance of conventional 3T magnetic resonance imaging and 1.5T magnetic resonance arthrography for the evaluation of internal derangement of the hip. Eur Radiol 2018; 28 (03) 963-971
  • 43 Zhang P, Li C, Wang W, Zhang B, Miao W, Liu Y. 3.0 T MRI is more recommended to detect acetabular labral tears than MR Arthrography: an updated meta-analysis of diagnostic accuracy. J Orthop Surg Res 2022; 17 (01) 126
  • 44 Blankenbaker DG, De Smet AA, Keene JS. MR arthrographic appearance of the postoperative acetabular labrum in patients with suspected recurrent labral tears. AJR Am J Roentgenol 2011; 197 (06) W1118-W1122
  • 45 Ziegert AJ, Blankenbaker DG, De Smet AA, Keene JS, Shinki K, Fine JP. Comparison of standard hip MR arthrographic imaging planes and sequences for detection of arthroscopically proven labral tear. AJR Am J Roentgenol 2009; 192 (05) 1397-1400
  • 46 Schmaranzer F, Todorski IAS, Lerch TD, Schwab J, Cullmann-Bastian J, Tannast M. Intra-articular lesions: imaging and surgical correlation. Semin Musculoskelet Radiol 2017; 21 (05) 487-506
  • 47 Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009; 2 (02) 105-117
  • 48 Studler U, Kalberer F, Leunig M. et al. MR arthrography of the hip: differentiation between an anterior sublabral recess as a normal variant and a labral tear. Radiology 2008; 249 (03) 947-954
  • 49 Blankenbaker DG, Tuite MJ. The painful hip: new concepts. Skeletal Radiol 2006; 35 (06) 352-370
  • 50 Kwee RM, Kavanagh EC, Adriaensen MEAPM. Normal anatomical variants of the labrum of the hip at magnetic resonance imaging: a systematic review. Eur Radiol 2013; 23 (06) 1694-1710
  • 51 Saddik D, Troupis J, Tirman P, O'Donnell J, Howells R. Prevalence and location of acetabular sublabral sulci at hip arthroscopy with retrospective MRI review. AJR Am J Roentgenol 2006; 187 (05) W507-W511
  • 52 Hodler J, Yu JS, Goodwin D, Haghighi P, Trudell D, Resnick D. MR arthrography of the hip: improved imaging of the acetabular labrum with histologic correlation in cadavers. AJR Am J Roentgenol 1995; 165 (04) 887-891
  • 53 Cotten A, Boutry N, Demondion X. et al. Acetabular labrum: MRI in asymptomatic volunteers. J Comput Assist Tomogr 1998; 22 (01) 1-7
  • 54 Banerjee P, McLean CR. Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med 2011; 4 (01) 23-32
  • 55 Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol 2007; 188 (06) 1540-1552
  • 56 Rhee C, Le Francois T, Byrd JWT, Glazebrook M, Wong I. Radiographic diagnosis of pincer-type femoroacetabular impingement: a systematic review. Orthop J Sports Med 2017; 5 (05) 23 25967117708307
  • 57 Mascarenhas VV, Castro MO, Rego PA. et al. The Lisbon Agreement on femoroacetabular impingement imaging-part 1: overview. Eur Radiol 2020; 30 (10) 5281-5297
  • 58 Zoga AC. Use of MRI instead of CT to assess femoral torsion in young patients prior to hip preservation surgery. Radiology 2020; 296 (02) 391-392
  • 59 Sbaraglia M, Bellan E, Dei Tos AP. The 2020 WHO Classification of Soft Tissue Tumours: news and perspectives. Pathologica 2021; 113 (02) 70-84
  • 60 Baroni E, Russo BD, Masquijo JJ, Bassini O, Miscione H. Pigmented villonodular synovitis of the knee in skeletally immature patients. J Child Orthop 2010; 4 (02) 123-127
  • 61 Turkucar S, Makay B, Tatari H, Unsal E. Pigmented villonodular synovitis: four pediatric cases and brief review of literature. J Postgrad Med 2019; 65 (04) 233-236
  • 62 Fang Y, Zhang Q. Recurrence of pigmented villonodular synovitis of the knee: a case report with review of literature on the risk factors causing recurrence. Medicine (Baltimore) 2020; 99 (16) e19856
  • 63 Echegaray-Casalduc G, Deliz-Jimenez D, SantaCruz-Casas A, Foy-Parrilla C. Recurrent diffuse pigmented villonodular synovitis in the hand of a pediatric patient: a case report. J Hand Surg Glob Online 2023; 5 (03) 382-385
  • 64 Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics 2007; 27 (05) 1465-1488
  • 65 Whitelaw CC, Varacallo M. Transient Synovitis. StatPearls Publishing; 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459181/ Accessed April 1, 2024
  • 66 Cruz Jr AI, Anari JB, Ramirez JM, Sankar WN, Baldwin KD. Distinguishing pediatric Lyme arthritis of the hip from transient synovitis and acute bacterial septic arthritis: a systematic review and meta-analysis. Cureus 2018; 10 (01) e2112
  • 67 Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am 1999; 81 (12) 1662-1670
  • 68 Yang WJ, Im SA, Lim GY. et al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol 2006; 36 (11) 1154-1158
  • 69 Liberman B, Herman A, Schindler A, Sherr-Lurie N, Ganel A, Givon U. The value of hip aspiration in pediatric transient synovitis. J Pediatr Orthop 2013; 33 (02) 124-127