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Paediatric Hip Disorder
Paediatric Hip Disorder
Painful hip conditions are often due to benign conditions known as transient synovitis of the hip. However, this must be distinguished from more serious conditions like hip infections, fractures or Perthes disease.
Transient synovitis of the hip, also known as toxic synovitis, is a temporary inflammation of the synovium (the lining of the hip joint). It is the most common cause of hip pain in children, typically affecting those between the ages of 3 and 8. Though the condition is usually mild and self-limiting, it can cause significant discomfort and temporary mobility issues.
It is better to be assessed by a doctor for this problem. Septic arthritis in children must be treated quickly, as infection can destroy the fragile cartilage of the hip. Once the hip is destroyed by infection, it will be a long-term problem for the child.
Symptoms
Hip Pain
Sudden onset of pain in the hip or groyne area. The pain may radiate down to the thigh or knee.
Limping or Refusal to Walk
Affected children may have difficulty walking, resulting in a noticeable limp or refusal to bear weight on the affected leg.
Limited Range of Motion
Stiffness or reduced hip movement ability, especially during internal rotation.
Low-Grade Fever (Occasional)
A mild fever may accompany the inflammation, though high fever is uncommon.
Pain Relief with Rest
Pain worsens with activity and improves with rest.
Causes
The exact cause of transient synovitis is not well understood, but it is often associated with the following:
- Viral Infections: Respiratory or gastrointestinal viral infections are commonly linked to the onset of transient synovitis.
- Minor Trauma: In some cases, a mild injury to the hip may precede symptoms.
- Allergic Reactions: Some theories suggest that an immune response to an infection or allergies may trigger the condition.
Risk Factors
- Age: Most common in children between 3 and 8 years old.
- Recent Viral Infection: Upper respiratory infections often precede the onset of transient synovitis.
- Male Gender: Boys are slightly more likely to develop transient synovitis than girls.
Diagnosis
Diagnosis of transient synovitis is primarily based on clinical evaluation, as the condition is self-limiting and does not cause lasting damage to the joint.
- Physical Examination: The orthopaedic specialist will assess hip mobility, mainly looking for pain during internal rotation.
- Imaging Studies:
- X-rays rule out other conditions like fractures or developmental dysplasia of the hip (DDH).
- Ultrasound: This may reveal excess fluid in the hip joint (effusion), a common feature of transient synovitis.
- Blood Tests: White blood cell counts and inflammatory markers (CRP, ESR) may be slightly elevated or normal. This helps differentiate transient synovitis from more serious conditions like septic arthritis.
- Joint Aspiration (Rare cases): If septic arthritis is suspected, fluid may be drawn from the joint to check for infection.
Rehabilitation
- Physical Activity: After the acute phase, children can gradually return to normal activities. There is typically no need for intensive rehabilitation as the condition does not cause long-term joint damage.
- Monitoring: Usually, follow-up visits are unnecessary unless symptoms worsen or persist longer than expected.
Complications
- Recurrence: Though rare, some children may experience transient synovitis more than once.
- Septic Arthritis (misdiagnosis): It is crucial to differentiate transient synovitis from septic arthritis, a severe bacterial infection of the joint, as the latter requires urgent treatment with antibiotics or surgery.
- Residual Hip Stiffness (rare): Some children may have minor hip stiffness that resolves over time.
When To See A Doctor
If your child develops sudden hip pain, limping, or difficulty walking, consult a healthcare professional for evaluation. While transient synovitis is usually not serious, it’s essential to rule out more severe conditions, such as septic arthritis or hip fractures.
Doctors In-Charge
Specialist Orthopaedic Surgeon
Specialist Orthopaedic Surgeon