The etiology of transient synovitis of the hip in childhood

The purpose of this paper is to assess the various factors that have been suggested in the etiology of the transient synovitis of the hip, and to determine the place of antibiotics. The benign self-limiting nature of this condition, which has also been called observation hip, irritable hip, coxitis fugax, coxitis serosa seu simplex and acute transient epiphysitis, has made it difficult to establish the cause. However, the condition is generally conceded to be the commonest cause of a painful hip in childhood (Wiles 1951, Ferguson 1954). CLINICAL FEATURES Transient synovitis mainly affects children under the age of ten years. Boys are more commonly affected than girls, in some series accounting for 80 per cent. One hip is not affected more often than the other, and affection of both has not been described. The onset may be abrupt or insidious. Symptoms vary in severity. They usually last for one to a few days, but sometimes for several weeks. The presenting symptom is pain in the hip, thigh or knee, or a limp. In the acute phase the child holds the leg in abduction and flexion. Hip movements are restricted in all directions, notably extension, abduction and lateral rotation. Tenderness over the hip joint is inconstant