The value of hip aspiration in pediatric transient synovitis.

INTRODUCTION

Hip transient synovitis (TS) is a common pediatric orthopaedic problem. Although a self-limiting illness, it often makes the patient temporarily disabled and poses a diagnostic difficulty because of its similarity to septic arthritis in clinical manifestations. The aim of this study was to evaluate the use of a single ultrasound-guided hip aspiration as a treatment modality for TS.

METHODS

Between the years 1984 and 1989, 112 children with TS were treated through bed rest and using nonsteroidal anti-inflammatory drugs (group 1). Between the years 1990 and 1999, 119 children diagnosed with TS were treated using hip aspiration, bed rest, and nonsteroidal anti-inflammatory drugs (group 2). Recovery parameters were compared between these patient groups.

RESULTS

Twenty-four hours after admission, limping was noted in 92% and 10% of the patients in groups 1 and 2, respectively, (P < 0.001). Refusal to bear weight was observed in 14% and 1% in groups 1 and 2, respectively, (P < 0.001), and hip joint pain was reported in 81% and 6% in groups 1 and 2, respectively, (P < 0.001). Larger joint effusions were found to be the reason behind the inability to bear weight.

CONCLUSIONS

Pain due to TS may be because of capsule stretching owing to the accumulation of joint effusion. Ultrasound-guided hip aspiration relieves pain and limitation in movement and provides rapid differential diagnosis from septic arthritis of the hip joint.