Assessment of atraumatic hip conditions in children

Specialty: Children's Orthopaedic
Age group: Children

Criteria for referral to public hospital service

• Undifferentiated hip pain
• Developmental dysplasia of the hips
• Suspected or confirmed Perthes disease.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the child, or their carer, and the referring clinician from referral to the health service
• Findings on physical examination including loss of hip motion
• Pain history: onset, location, nature of pain and duration
• Details of previous management and pain management including the course of treatment(s) and outcome of treatment(s)
• For undifferentiated hip pain
  • if younger than 6 months ultrasound of the hips (paediatric ultrasound if possible) (including details of the diagnostic imaging practice)
  • if older than 6 months x-ray of the hips (paediatric x-ray if possible) (including details of the diagnostic imaging practice).
• For developmental dysplasia of the hips
  • positive Ortolani’s or Barlow’s test
  • limited hip abduction
  • leg length discrepancy
  • if younger than 6 months ultrasound of the hips (paediatric ultrasound if possible) (including details of the diagnostic imaging practice)
  • if older than 6 months x-ray of the hips (paediatric x-ray if possible) (including details of the diagnostic imaging practice)
• For Perthe’s disease
  • onset nature and duration of symptoms including limp or hip irritability
  • details of previous management including the course of treatment(s) and outcome of treatment(s)
  • pelvic x-ray: anteroposterior (AP) and frog leg views (including details of the diagnostic imaging practice).

Provide if available

• Statement about the parent(s) or guardian’s interest in having surgical treatment if that is a possible intervention
• If the child is neurodiverse, gender diverse or has a disability
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If the child is aged 14 to 18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

All patients with suspected or confirmed slipped upper femoral epiphysis (SUFE) should be referred to an appropriate emergency department for an orthopaedic assessment, public hospital specialist clinics should not receive any referrals for this presenting problem.

Requests for paediatric hip imaging should be directed to an appropriate service that see high volume paediatric hip problems and have appropriately trained paediatric radiologists.

Where possible the referring clinician should complete an image transfer request form so that images are transferred to the hospital receiving the referral.

The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

Not applicable.