PediatricsA randomized clinical trial: Should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs?*,**,★
Introduction
Patients with transient synovitis of the hip (“irritable hip”) present frequently to the pediatric emergency department. Transient synovitis of the hip is a benign self-limiting condition most commonly occurring in children between the ages of 3 and 10 years. It causes pain on movement of the hip resulting from sterile inflammation of the joint and may cause limp or inability to walk. Resolution usually occurs spontaneously in less than 7 days, but the condition is distressing for both parents and children.1
The cause of transient synovitis of the hip remains unknown, and although infection (either acute or as a postinfectious phenomenon) has been postulated as a possible cause, no definitive agent has been identified.2, 3 There is some speculation regarding a link between transient synovitis and Perthes' disease of the hip, because a small number of patients in long-term studies subsequently develop Perthes' disease.3, 4 However, because most patients with transient synovitis of the hip do not develop this complication or demonstrate vascular insufficiency on radionuclide scanning,5 it may be that the conditions are not related but can occasionally present in a similar fashion.
There have been a number of articles published on methods to discriminate between transient synovitis of the hip and other more serious pathology.6, 7, 8, 9 There has been little published on the treatment aspects of transient synovitis of the hip or on the natural history in the short term.
Ibuprofen has been found to be safe and effective when used as an anti-inflammatory agent for children with other conditions.10, 11 This has led to our hypothesis that ibuprofen may shorten the duration of symptoms by reducing inflammation and by reducing pain in patients with transient synovitis of the hip. To date, to our knowledge, there have been no trials looking at the effectiveness and safety of nonsteroidal anti-inflammatory drugs (NSAIDS) in this condition, although they have been used by some clinicians.
Section snippets
Materials and methods
The study was conducted in a large pediatric ED between July 1997 and July 1998. All children with the clinical diagnosis of transient synovitis of the hip (apart from those presenting on weekends because of the difficulty in consistently obtaining an ultrasonographic scan within 24 hours) were eligible for enrollment. A clinical diagnosis was made on the basis of pain, limp, or both, with an examination revealing limitation of hip movement or pain localized by the child to the hip joint.
Results
Forty patients were enrolled over the 12-month period, but there were 4 patients who were excluded from the final analysis (Figure 1).One patient received placebo and was excluded when the ESR was noted the following day to be 60 mm/h. He was recalled and admitted for intravenous antibiotics, but the final
Discussion
Our study suggests that NSAIDS (in this case, ibuprofen) may hasten the recovery of patients with a clinical diagnosis of transient synovitis of the hip. Although the natural history of transient synovitis of the hip is resolution within 5 to 7 days,1 parents and children prefer resolution in the shortest possible time. Because both groups used paracetamol for pain relief, it is likely that the shorter duration in the ibuprofen group was a result of the anti-inflammatory effects.
Hip effusion
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An investigation into the aetiology of irritable hip
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Transient synovitis of the hip. Its incidence, epidemiology and relation to Perthes' disease
J Bone Joint Surg Br
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Radionuclide scanning in the early diagnosis of Perthes' disease
J Bone Joint Surg Br
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Evaluation of acute gait abnormalities in preschool children
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Management of irritable hip: a review of hospital admission policy
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Cited by (35)
Hip pain evaluation and treatment for athletes
2023, The Youth Athlete: A Practitioner's Guide to Providing Comprehensive Sports Medicine CareClinical trials and future perspectives of antiinflammatory agents
2023, Recent Developments in Anti-Inflammatory TherapyTransient Synovitis
2018, Principles and Practice of Pediatric Infectious DiseasesPediatric Nontraumatic Hip Pathology
2016, Clinical Pediatric Emergency MedicineCitation Excerpt :A study of patients with transient synovitis followed with serial examinations and ultrasound found full symptom and effusion resolution by 7 days in 60% of patients and 100% symptom resolution with 84% effusion resolution by 14 days.19 A randomized clinical trial in children with transient synovitis showed a decrease in symptoms from 4.5 days in the placebo group to 2 days the ibuprofen group.20 If there is a recurrence of transient synovitis, it typically takes place within the first year but can occur more remotely in a small portion of patients.21
Transient synovitis of the hip as a complication of chickenpox in infant: Case study
2012, Saudi Pharmaceutical JournalCitation Excerpt :Ibuprofen, diclofenac sodium and paracetamol are some of the best analgesics in this particular case. Some studies show that treatment with ibuprofen may reduce the duration of the disease (Kermond et al., 2002). Even though some complications of chickenpox might be very rare, it is essential to consider all of them when the patients are very young children.
Transient Synovitis
2012, Principles and Practice of Pediatric Infectious Diseases, Fourth Edition
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Author contributions: SK and PB conceived and designed this study with advice from KG. SK and PB recruited patients and collected data. JC provided advice on study design and analyzed the data. MF coordinated ultrasonography and reviewed and reported on all ultrasonographic scans. SK drafted the manuscript, and all authors were involved substantially in its revision. SK takes responsibility for the paper as a whole.
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Supported by a research grant from The Boots Company PLC, Melbourne, Victoria, Australia.
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Address for reprints: Susan Kermond, MBBS, FRACP, 11 Canora Street, Blackburn South, Victoria 3130, Australia; 03 9899 1775;,E-mail [email protected]