Symptoms
In infectious inflammation of the hip joint, the inflammation causes severe pain, which typically radiates into the groin. Patients describe it as very unpleasant and dragging. Due to the severe pain, the affected person often takes a relieving posture.
He rotates the leg slightly outwards and holds it in a slightly bent position. In this way, the pain is often relieved and a full load is usually no longer possible. Typically, the disease also leads to a pathological gait pattern.
In order to relieve the hip when walking, the upper body is inclined to the healthy side if necessary, and the weight is shifted to the functional leg. In addition to the general signs of inflammation, fever, fatigue and reduced performance also occur. The affected person feels flabby, tired and unwell.
In children, the inflammation in the hip joint (Coxitis fugax) can often become purulent. The accumulation of pus in the joint space then exerts enormous pressure on the joint, which is not yet as stable as in an adult. Depending on its severity, this can lead to dislocation of the joint (dislocation) or to reduced supply of the cartilaginous parts of the joint.
Children are not yet able to indicate the pain so precisely.They are often non-specific and are usually indicated as knee joint pain. The limping gait is conspicuous in children, and movement is often restricted and painful. Especially the rotation (turning of the leg in the hip joint) causes pain.
Here, treatment is urgently required, as otherwise it may also lead to damage to the growth joints, which may cause malpositioning during the growth of the child. Hip necrosis (Perthes disease) shows similar symptoms. The diagnosis generally includes an initial examination of the blood.
An increase in C-reactive protein (CRP), a protein that is elevated in the blood during the acute phase of an inflammation, and an increase in white blood cells (leukocytes) indicate an inflammation in the body. In addition, the blood cell sedimentation rate (BSG) is increased. A puncture may be necessary to determine the pathogens: After the skin above the hip joint has been thoroughly disinfected, the doctor inserts a thin hollow needle, also called a trocar, into the joint space and draws in some liquid with a syringe attached to it.
In the microbiological laboratory, this sample can be examined in detail for bacteria. This determination is especially important for the subsequent treatment with antibiotics, since the different bacteria are also killed differently by the medication. By means of an x-ray or in some cases also computer tomography or magnetic resonance imaging of the hip (also MRI of the hip) for a better visualization of the soft tissues, the exact localization of the focus of inflammation can be determined and the extent can be assessed, after which an appropriate therapy can be initiated.
In the case of infantile hip joint inflammation (Coxitis fugax), further diagnostics includes an ultrasound examination (sonography). In children, the structures can be visualized very well, while x-rays are inconspicuous in this case. Sonography can reveal an effusion in the joint. The differential diagnosis should be distinguished from coxitis fugax, hip rhinitis in children, hip necrosis of unknown cause (Perthes disease). This form of inflammation can be distinguished from hip fever by means of X-rays and ultrasound.