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1 · SNAPSHOT

Paediatric Hip Conditions (Screening) body chart — Illustrative, not diagnostic. Canva body chart for Paediatric Hip Conditions (Screening).

Who: A limping child.
What: Four conditions sharing one presentation.
How it behaves: Limp, with hip, thigh or knee pain. Acute (transient synovitis, SCFE) or insidious (Perthes). Worse with activity. May report night pain or fever. Parents say "limping," "stiffness," "refuses to walk."

The one thing to take from this page:

Knee pain in a child can come from the hip — and one of the four things it might be destroys a joint in days. Investigate every limping child. You are screening, not treating.

One presentation, four destinations

	The child	Why it matters
Transient synovitis	Systemically well. Often post-viral. Commonest	Still needs follow-up — see below
Septic arthritis	Fever, unwell, refuses to weight-bear	EMERGENCY. Days, not weeks
SCFE	Adolescent, often overweight. ↓ internal rotation, obligate external rotation on flexion	Slip progresses; osteonecrosis follows
Perthes	Younger child, insidious, progressive stiffness	Can appear after a transient synovitis diagnosis

⚠️ Transient synovitis is not always a discharge diagnosis. Follow them up.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order — but the screening questions come first here, because one answer sends the child to an emergency department.

SCREENING FIRST

Is there a fever? Have they been unwell?
Will they weight-bear at all? "Refuses to walk + pain" is a red flag.
How quickly did this come on?
Any recent illness? Transient synovitis has been reported as a sequela of viral illness including COVID-19 [1].
Any night pain, weight loss, or systemic symptoms?

MAIN PROBLEM

"He's been limping since the weekend."
"She says her knee hurts."
"He won't put weight on it."

BODY CHART

Groin, thigh, or knee. Mark the knee if that is what they say — then examine the hip.
Ask the child to point. Young children localise poorly.
Bilateral? Changes the thinking.

BEHAVIOUR AND HISTORY

	Points toward
Acute, systemically well, recent viral illness	Transient synovitis
Acute, febrile, unwell, refuses to weight-bear	Septic arthritis
Adolescent, often overweight, weeks of vague thigh or knee pain	SCFE
Younger child, insidious, weeks to months, progressive stiffness	Perthes
Night pain, weight loss, no mechanical story	Malignancy

Age. The single most useful discriminator you have.
Duration and trajectory. Days versus weeks versus months.
Any medication? Transient synovitis has been reported in association with leuprolide [2].
Any endocrine condition or growth concern? Relevant in SCFE.

Assessing this region? Download the Hip & Groin assessment template →

3 · HYPOTHESIS RANKING

Pattern	The one discriminating feature
Septic arthritis	Fever, systemic illness, refusal to weight-bear, raised inflammatory markers. THE emergency.
Transient synovitis	Commonest. Often post-viral. Child is systemically well. Still needs follow-up.
SCFE	Adolescent, often overweight. Restricted internal rotation and obligate external rotation as the hip flexes.
Perthes	Younger child, insidious, progressive stiffness — and it can present after a transient synovitis diagnosis.
Bone or soft-tissue malignancy	Night pain, systemic symptoms, no mechanical story.

The decision that matters most

Septic arthritis versus transient synovitis. Read further: clinical indicators that distinguish them [3], a validated diagnostic algorithm for transient synovitis [4], point-of-care ultrasound decision rules [5], hip joint effusion prevalence in transient synovitis [6].

The features are named on this page. The decision rule and its thresholds are not — because applying a cut-off to decide whether a febrile child has a septic joint is not a physiotherapist's job. Your job is to recognise the possibility and escalate the same hour.

And the age-based shortcut

Age narrows this faster than anything else. Toddler to young child: transient synovitis, septic arthritis, Perthes. Adolescent: SCFE, septic arthritis. Any age: malignancy.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated. This whole page is.

Finding	What it suggests	What you do
Fever with a painful hip	Septic arthritis	EMERGENCY — same hour
Refuses to weight-bear	Septic arthritis, fracture, SCFE	Urgent medical review
Unwell, lethargic, off food	Infection, systemic disease	EMERGENCY
Adolescent with restricted internal rotation and a limp	SCFE	Urgent imaging and orthopaedic review. Keep them non-weight-bearing
Obligate external rotation as the hip flexes	SCFE	Urgent orthopaedic review
Knee pain in a child with a normal knee	Hip pathology	Examine and image the hip
Insidious limp with progressive stiffness in a young child	Perthes	Imaging and paediatric orthopaedic review
Night pain, weight loss, no mechanical story	Malignancy	Urgent medical review

The rule: there isn't one. A limping child gets investigated. This page has no "yours" column — hip pain in a child is always a referral question, and the physiotherapy starts after somebody else has named the diagnosis.

Cross-links: Osgood-Schlatter disease · Sinding-Larsen-Johansson syndrome · Hip / pelvic stress fracture · Septic arthritis / DVT / tumour

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Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

Australian anchor: the Royal Children's Hospital Melbourne clinical practice guideline, The limping or non-weight bearing child (state; updated 2025): causes by age, red flags, when to X-ray and when to consult.

It states that septic arthritis is an orthopaedic emergency to suspect in any child presenting with limp, swelling and reduced range of motion, especially with fever. The decisions are anchored to the meta-analysis of clinical indicators distinguishing septic arthritis from paediatric transient synovitis (QingSong et al. 2024, PMID 39695443) — the highest-value decision on the page — and to the newly developed and validated diagnostic algorithm for transient synovitis (Benoit et al. 2024, PMID 38366676).

PubMed Source

The RCH guideline is a state paediatric-hospital guideline, not a national one; the two evidence anchors are not guidelines and not Australian. This is a screening page, not a treatment page — a physiotherapist's job here is recognition and referral, and every definitive management pathway on it belongs to a paediatric orthopaedic or medical team.

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The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 20

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Every source on this page resolves and title-verifies against PubMed. Newest first.

2025Murray et al. (2025). Transient Synovitis as a Sequela of COVID-19 Infection: A Case Report and Review of Literature. Journal of orthopaedic case reports, 15(2), 28-31. https://doi.org/10.13107/jocr.2025.v15.i02.5216
2024Steen & Phillips (2024). Transient synovitis associated with leuprolide depot (Lupron). Endocrinology, diabetes & metabolism case reports, 2024(3). https://doi.org/10.1530/EDM-24-0031
2024QingSong et al. (2024). Clinical indicators for distinguishing septic arthritis from paediatric transient synovitis of the hip: a systematic review and meta-analysis. BMC infectious diseases, 24(1), 1432. https://doi.org/10.1186/s12879-024-10341-z
2024Benoit et al. (2024). Transient synovitis of the hip: Development and validation of a new diagnostic algorithm. Acta paediatrica (Oslo, Norway : 1992), 113(6), 1396-1403. https://doi.org/10.1111/apa.17144
2025McCreary et al. (2025). Can a POCUS Clinical Decision Rule Improve Reliability in the Diagnosis of Paediatric Transient Synovitis of the Hip? A Single Centre Pilot Study. POCUS journal, 10(2), 103-108. https://doi.org/10.24908/pocusj.v10i02.18290
2026Shles et al. (2026). Prevalence of Hip Joint Effusion in Children Diagnosed With Transient Synovitis in the Pediatric Emergency Department. Pediatric emergency care, 42(7), e94-e98. https://doi.org/10.1097/PEC.0000000000003597
2024De Angelis et al. (2024). Novelties in slipped capital femoral epiphysis imaging: A narrative review. Heliyon, 10(7), e28734. https://doi.org/10.1016/j.heliyon.2024.e28734
2024Zhao et al. (2024). Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index. Scientific reports, 14(1), 28638. https://doi.org/10.1038/s41598-024-79805-1
2024Mashabi et al. (2024). Gait Compensation among Children with Non-Operative Legg-Calvé-Perthes Disease: A Systematic Review. Healthcare (Basel, Switzerland), 12(9). https://doi.org/10.3390/healthcare12090895
2024Zusman et al. (2024). Quantifying Risk Factors for Slipped Capital Femoral Epiphysis and Postslip Osteonecrosis. Journal of pediatric orthopedics, 44(1), e30-e34. https://doi.org/10.1097/BPO.0000000000002539
2024Howard et al. (2024). Stable slipped capital femoral epiphysis with significant deformity. The bone & joint journal, 106-B(2), 111-113. https://doi.org/10.1302/0301-620X.106B2.BJJ-2023-1027
2024Xinling et al. (2024). The prevalence of Legg-Calvé-Perthes disease among paediatric patients with transient synovitis of the hip: a systematic review and meta-analysis. Journal of orthopaedic surgery and research, 19(1), 560. https://doi.org/10.1186/s13018-024-05070-7
2024Ng et al. (2024). Legg-Calvé-Perthes Disease: Diagnosis, Decision Making, and Outcome. Current sports medicine reports, 23(2), 45-52. https://doi.org/10.1249/JSR.0000000000001139
2024Santos Santana MA et al. (2024). Effectiveness of therapeutic methods for Legg-Calvé-Perthes disease according to staging, limits of conservative treatment: a systematic review with meta-analysis. Orthopedic reviews, 16, 122123. https://doi.org/10.52965/001c.122123
2025Braun et al. (2025). Legg-Calvé-Perthes disease- surgical treatment options. Archives of orthopaedic and trauma surgery, 145(1), 186. https://doi.org/10.1007/s00402-025-05801-3
2026Laungani et al. (2026). Nationwide Epidemiological and Demographic Evolution of Legg-Calvé-Perthes Disease: A 10-Year Analysis. Journal of the Pediatric Orthopaedic Society of North America, 16, 100394. https://doi.org/10.1016/j.jposna.2026.100394
2026Gilbert et al. (2026). Legg-Calvé-Perthes Disease. The Journal of the American Academy of Orthopaedic Surgeons, 34(4), e488-e497. https://doi.org/10.5435/JAAOS-D-24-01469
2024Hwang et al. (2024). Incidence and Clinical Characteristics of Slipped Capital Femoral Epiphysis in Patients with Endocrinopathy: A Population-Based Cohort Study. The Journal of bone and joint surgery. American volume, 106(5), 381-388. https://doi.org/10.2106/JBJS.23.00790
2025White et al. (2025). The Seasonal Incidence of Slipped Capital Femoral Epiphysis: A Systematic Review and Meta-Analysis. Children (Basel, Switzerland), 12(6). https://doi.org/10.3390/children12060729
2025Chen et al. (2025). Multicenter epidemiological investigation and analysis of factors associated with transient synovitis of the hip in 5065 children treated across 32 tertiary children's hospitals in China. BMC musculoskeletal disorders, 26(1), 1021. https://doi.org/10.1186/s12891-025-09224-4

Mapped to this pattern

HOOS
Hip Disability and Osteoarthritis Outcome Score
hip disability and osteoarthritis outcome · 40 items · 10 min

Generic measures that also apply

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