Dear Sarath,

Your point about general practitioners not being aware of serious hip problems in children is very valid. When they are missed by senior doctors in the UK, I can well understand how a rural practitioners or a primary health centre can easily miss them in India. I would be interested to find out how we can mitigate this problem or how to spread the message.

Vishal mentions that it is important to rule out hip pathology in children presenting with thigh and knee pain. It is very important indeed. In UK I have come across adult patients who presented with knee pain being posted for Knee replacement. Many of these patients in the NHS are transferred to other surgeons because of the long surgical waiting lists. On two or three occasions when I took over these patients and examined them for a preoperative check I was often horrified to note that they had minor arthritis in the knee and severe arthritic changes in the hip. A hip replacement cured their knee pain like magic! So it is not just the children. Symptoms of knee pain with pathology in the hip can also occur in adults