Transient synovitis of the hip: which investigations are truly useful?

Abstract

QUESTIONS UNDER STUDY/PRINCIPLES:

To assess the usefulness of several laboratory and radiological investigations for the limping child with suspected transient synovitis of the hip.

METHODS:

The medical records of children admitted at our children's hospital for nontraumatic hip pain between 1999 and 2007 were retrospectively reviewed. During the study period, all children without a definite diagnosis after routine investigations in the emergency department were admitted and a specific work-up including antinuclear antibodies titre, rheumatoid factor, antistreptolysin O titre, Lyme disease serology and hip ultrasonography were obtained. Children were systematically re-evaluated 6 weeks after hospital discharge, with a clinical examination and radiological hip views. Patients were diagnosed with transient synovitis of the hip if an ultrasound-confirmed hip effusion was present at time of admission, complete resolution of symptoms occurred without any specific treatment, and no other pathology of the hip was identified during follow-up.

RESULTS:

A total of 417 cases without definite diagnosis were admitted and were submitted to a specific work-up. Transient synovitis of the hip was subsequently diagnosed in 383 patients, septic arthritis in 1 patient, and Lyme arthritis in 1 patient. Thirty-two patients remained without diagnosis. No rheumatological condition was found.

CONCLUSION:

Our results suggest that most investigations performed during the initial work-up in patients suspected transient synovitis of the hip are unnecessary and should routinely include only white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and hip radiography and ultrasonography. No further investigations are necessary during follow-up for transient synovitis of the hip in asymptomatic children.

• Authors: Victor Dubois-Ferrière, Wilson Belaieff, Pierre Lascombes, Geraldo de Coulon, Dimitri Ceroni
• Journal: Swiss medical weekly (Swiss Med Wkly) Vol. 145 Pg. w14176 ( 2015) ISSN: 1424-3997 [Electronic] Switzerland
• PMID: 26295841 (Publication Type: Journal Article)

Chemical References

• C-Reactive Protein

Topics

• Algorithms
• Blood Sedimentation
• C-Reactive Protein
• Diagnosis, Differential
• Emergency Service, Hospital
• Female
• Hip (diagnostic imaging)
• Hospitals, Pediatric (organization & administration)
• Humans
• Leukocyte Count
• Male
• Pain (etiology)
• Radiography
• Retrospective Studies
• Synovitis (blood, diagnosis)
• Ultrasonography