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Original article

Vol. 145 No. 3334 (2015)

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

  • Victor Dubois-Ferrière
  • Wilson Belaieff
  • Pierre Lascombes
  • Geraldo de Coulon
  • Dimitri Ceroni
Cite this as:
Swiss Med Wkly. 2015;145:w14176


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.


  1. Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW. Acute non-traumatic hip pathology in children: incidence and presentation in family practice. Fam Pract. 2010;27(2):166–70.
  2. Landin LA, Danielsson LG, Wattsgard C. Transient synovitis of the hip. Its incidence, epidemiology and relation to Perthes' disease. J Bone Joint Surg Br. 1987;69(2):238–42.
  3. Haueisen DC, Weiner DS, Weiner SD. The characterization of "transient synovitis of the hip" in children. J Pediatr Orthop. 1986;6(1):11–7.
  4. Eich GF, Superti-Furga A, Umbricht FS, Willi UV. The painful hip: evaluation of criteria for clinical decision-making. Eur J Pediatr. 1999;158(11):923–8.
  5. Fischer SU, Beattie TF. The limping child: epidemiology, assessment and outcome. J Bone Joint Surg Br 1999;81(6):1029–34.
  6. Taylor GR, Clarke NM. Management of irritable hip: a review of hospital admission policy. Arch Dis Child 1994;71(1):59–63.
  7. Bickerstaff DR, Neal LM, Brennan PO, Bell MJ. An investigation into the etiology of irritable hip. Clin Pediatr (Phila) 1991;30(6):353–6.
  8. Caird MS, Flynn JM, Leung YL, Millman JE, D'Italia JG, Dormans JP. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. 2006;88(6):1251–7.
  9. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999;81(12):1662–70.
  10. Kastrissianakis K, Beattie TF. Transient synovitis of the hip: more evidence for a viral aetiology. Eur J Emerg Med. 2010;17(5):270–3.
  11. Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 2004;86-A(8):1629–35.
  12. Ceroni D, Cherkaoui A, Ferey S, Kaelin A, Schrenzel J. Kingella kingae osteoarticular infections in young children: clinical features and contribution of a new specific real-time PCR assay to the diagnosis. J Pediatr Orthop. 2010;30(3):301–4.
  13. Yagupsky P, Porsch E, St Geme JW, 3rd. Kingella kingae: an emerging pathogen in young children. Pediatrics. 2011;127(3):557–65.
  14. Terjesen T, Osthus P. Ultrasound in the diagnosis and follow-up of transient synovitis of the hip. J Pediatr Orthop 1991;11(5):608–13.
  15. Royle SG. Investigation of the irritable hip. J Pediatr Orthop. 1992;12(3):396–7.
  16. Hardinge K. The etiology of transient synovitis of the hip in childhood. J Bone Joint Surg Br. 1970;52(1):100–7.
  17. Adams JA. Transient Synovitis of the Hip Joint in Children. J Bone Joint Surg Br. 1963;45:471–6.
  18. Futami T, Kasahara Y, Suzuki S, Ushikubo S, Tsuchiya T. Ultrasonography in transient synovitis and early Perthes' disease. J Bone Joint Surg Br. 1991;73(4):635–9.
  19. Wingstrand H. Transient synovitis of the hip in the child. Acta Orthop Scand Suppl. 1986;219:1–61.
  20. Gordon JE, Huang M, Dobbs M, Luhmann SJ, Szymanski DA, Schoenecker PL. Causes of false-negative ultrasound scans in the diagnosis of septic arthritis of the hip in children. Journal of pediatric orthopedics. 2002;22(3):312–6.
  21. Zamzam MM. The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children. J Pediatr Orthop B. 2006;15(6):418–22.
  22. Zawin JK, Hoffer FA, Rand FF, Teele RL. Joint effusion in children with an irritable hip: US diagnosis and aspiration. Radiology. 1993;187(2):459–63.
  23. Gordis L. The virtual disappearance of rheumatic fever in the United States: lessons in the rise and fall of disease. T. Duckett Jones memorial lecture. Circulation. 1985;72(6):1155–62.
  24. Uziel Y, Perl L, Barash J, Hashkes PJ. Post-streptococcal reactive arthritis in children: a distinct entity from acute rheumatic fever. Pediatr Rheumatol Online J. 2011;9(1):32.
  25. Riise OR, Lee A, Cvancarova M, Handeland KS, Wathne KO, Nakstad B, et al. Recent-onset childhood arthritis--association with Streptococcus pyogenes in a population-based study. Rheumatology (Oxford). 2008;47(7):1006–11.
  26. Simonini G, Taddio A, Cimaz R. No evidence yet to change American Heart Association recommendations for poststreptococcal reactive arthritis: comment on the article by van Bemmel et al. Arthritis Rheum. 2009;60(11):3516–8; author reply 3518–9.
  27. Gerber MA, Zemel LS, Shapiro ED. Lyme arthritis in children: clinical epidemiology and long-term outcomes. Pediatrics. 1998;102(4 Pt 1):905–8.
  28. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MR, et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. Arthritis Rheum. 1977;20(1):7–17.
  29. Saulsbury FT. Lyme arthritis presenting as transient synovitis of the hip. Clinical pediatrics. 2008;47(8):833–5.
  30. Cleary AG, Sills JA, Davidson JE: Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol. 2000;27(6):1568.
  31. McGhee JL, Kickingbird LM, Jarvis JN. Clinical utility of antinuclear antibody tests in children. BMC Pediatr. 2004;4:13.
  32. Serra CR, Rodrigues SH, Silva NP, Sztajnbok FR, Andrade LE. Clinical significance of anticardiolipin antibodies in juvenile idiopathic arthritis. Clin Exp Rheumatol. 1999;17(3):375–80.
  33. Berntson L, Andersson Gare B, Fasth A, Herlin T, Kristinsson J, Lahdenne P, et al. Incidence of juvenile idiopathic arthritis in the Nordic countries. A population based study with special reference to the validity of the ILAR and EULAR criteria. J Rheumatol. 2003;30(10):2275–82.
  34. Wong KO, Bond K, Homik J, Ellsworth JE, Karkhaneh M, Ha C, et al. In: Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Tests for Evaluating Musculoskeletal Complaints in Children. edn. Rockville (MD). 2012.
  35. Mattick A, Turner A, Ferguson J, Beattie T, Sharp J. Seven year follow up of children presenting to the accident and emergency department with irritable hip. J Accid Emerg Med. 1999;16(5):345–7.

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