Transient synovitis of the hip : is systematic radiological screening necessary for the detection of Perthes disease?

Current imaging guidelines in Belgium advise a systematic X-ray screening of the hips after an episode of transient synovitis of the hip, in order to detect Perthes disease. The aim of this study was to analyze whether systematic radiological screening is necessary for all children or whether the X-ray indication could be guided by clinical symptoms. A retrospective single center study including all children with the diagnosis of transient synovitis of the hip between 2013 and 2018 was performed. 242 patients with the diagnosis of one or more transient synovitis episodes were included, 102 of whom underwent a follow up X-ray. Persistence or recurrence of symptoms were recorded for all patients, as well as the results of follow-up hip X-rays. 12 children did not remain symptom-free after the episode of transient synovitis. Of these patients 10 had a normal follow-up X-ray and 3 were diagnosed with Perthes disease. 1 patient of those 3 had a normal X-ray but was diagnosed with Perthes disease on MRI. Of the children which remained symptom-free after the episode of transient synovitis, none were diagnosed with Perthes disease afterwards. A follow-up X-ray to exclude Perthes disease after a diagnosis of transient hip synovitis appears to be necessary only in patients with persistent or recurrent symptomatology.

Pancytopenia and transient synovitis of hip joint in a SARS CoV-2 positive pregnant female: a case report

Pregnant women are at an increased risk for severe COVID-19 illness. Apart from the typical clinical manifestations, atypical presenting features of COVID-19 are also being found. We report the case of a 20 years old COVID positive antenatal patient with pancytopenia. The patient presented with scar tenderness and was taken up for emergency caesarean section at a platelet count of 5860 per microlitre. She was managed with intraoperative and postoperative transfusion of blood products. She developed chronic persistent hip pain and was diagnosed to have transient synovitis of the hip joint, which was managed conservatively. COVID-19 is a new disease with evolving clinical presentation. Pancytopenia and synovitis of hip are a rare manifestation of COVID-19 and has never been reported in a pregnant woman with COVID-19.

How not to miss infective causes of hip pain in children

A referral from accident and emergency for a child with hip pain is a scenario commonly faced by orthopaedic juniors on call. The list of differentials is vast and can make assessment and diagnosis challenging, with severe consequences if diagnosis is delayed or missed. Three common causes of paediatric hip pain are septic arthritis, transient synovitis and osteomyelitis. These can all present as a child with atraumatic hip pain, irritability, fever and refusal to weight bear. Differentiating between them can be challenging. A thorough history and examination, combined with appropriate investigations and imaging, is essential. Early diagnosis and prompt treatment are key to reducing irreversible secondary sequelae of joint destruction and long-term functional impairment.

Dose-Finding in the Development of an LPS-Induced Model of Synovitis in Sheep

Models of transient synovitis that can be controlled with antiinflammatory and analgesic drugs have been used to study pain amelioration. To this end, we aimed to determine the dose of intraarticularly administered E. coli LPS that induced signs of synovitis without systemic signs in clinically healthy male castrated sheep (n = 14). In phase 1, a single dose of LPS (0.5, 1.0, 1.5, or 2.0 ng in a total volume of 0.5 mL) was administered into the right stifle joint. In phase 2, a dose of LPS (1.0 or 2.0 μg) in 0.3 mL was administered to 4 naïve sheep. In phase 3, 4 sheep from phase 1 were inoculated after a 60 d washout period with either 0.5 or 1.0 μg of LPS. During the first 48 h after LPS administration, the following were performed: assessment of clinical parameters; scoring for lameness, pain on limb flexion, and local swelling; and ultrasonography of the joints were performed. The doses tested during phase 1 produced subtle signs. During phase 2, mild to moderate lameness with no evidence of systemic signs occurred at both doses. In phase 3, clinical responses were similar between the 0.5- and 1-μg doses. Signs of swelling were not observed at any time. Therefore, we consider the 0.5-μg to be the most appropriate for this model, because it was the lowest dose tested capable of causing lameness without signs of systemic inflammation in all animals.