What is the treatment for transient synovitis of the hip?

Treatment of Transient Synovitis of the Hip

The treatment of transient synovitis of the hip consists primarily of rest and nonsteroidal anti-inflammatory drugs (NSAIDs), which effectively reduce symptoms and accelerate recovery. 1, 2

Diagnosis and Differentiation

Before initiating treatment, it's crucial to rule out more serious conditions, particularly septic arthritis:

• Suspect septic arthritis if the patient presents with:

  • Severe pain or spasm on hip movement or palpation
  • Temperature higher than 37.5°C (99.5°F)
  • Erythrocyte sedimentation rate (ESR) ≥20 mm/hr 1

• Transient synovitis is typically characterized by:

  • Acute onset of hip pain lasting 1-3 days
  • Limping or refusal to bear weight
  • Absence of fever
  • Normal inflammatory markers (WBC, CRP, ESR)
  • Normal radiographs 1, 3

Treatment Algorithm

1. First-line treatment:

   • Bed rest to reduce inflammation and pain 1, 4
   • NSAIDs (e.g., ibuprofen 10 mg/kg three times daily for 5 days) 2

2. Monitoring:

   • Regular temperature checks to exclude onset of fever 1
   • Follow-up within 7-10 days if symptoms persist 1

3. Additional interventions:

   • In cases with significant joint effusion causing pain and limited movement, ultrasound-guided hip aspiration may provide rapid relief and help differentiate from septic arthritis 5

Evidence for Treatment Efficacy

• A randomized clinical trial demonstrated that ibuprofen (10 mg/kg three times daily for 5 days) significantly shortened the duration of symptoms compared to placebo (median 2 days vs. 4.5 days) 2

• Ultrasound-guided hip aspiration has been shown to provide faster relief of symptoms compared to conservative management alone:

  • 24 hours after admission, limping was present in only 10% of patients treated with aspiration compared to 92% in those treated with rest and NSAIDs alone
  • Hip joint pain was reported in only 6% of patients treated with aspiration compared to 81% in those treated with conservative management 5

Expected Course and Follow-up

• Transient synovitis is self-limiting with no residual sequelae, though recurrences are possible 4
• Symptoms typically resolve within one week with appropriate treatment 3
• If significant pain and limping persist for 7-10 days after initial presentation, the patient should be reevaluated to rule out other conditions 1

Cautions and Pitfalls

• Transient synovitis remains a diagnosis of exclusion; septic arthritis must be ruled out first 1, 4
• Hip aspiration is the diagnostic procedure of choice if septic arthritis is suspected 1
• NSAIDs may cause minor gastrointestinal side effects in some patients (reported in approximately 24% of patients in clinical trials) 2