The Irritable Hip Syndrome in Children:<i>A Long-Term Follow-up</i>

Sharwood, P

doi:10.3109/17453678108992159

Cited by 38 publications

(12 citation statements)

References 7 publications

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“…Infections of the upper respiratory tract are thought to be particularly important as a predisposing factor in the 'irritable hip'. 3,5,7,8,10,15,20,21 This has never been proven by an identifiable cause or agent, but our results confirm the need for further studies.…”

Section: 913supporting

confidence: 57%

“…[2][3][4][5][6][7][8][9][10][11][12][13] Most have concentrated on specific diseases such as 'irritable hip', which includes transient synovitis/toxic synovitis or orthopaedic infections. [2][3][4][5][6][7][8][9][10][11][12]14,15 Often, however, children do not present to their general practitioner or the AED with a specific diagnosis and doctors faced with the limping child must make an appropriate assessment and ensure correct management. Taylor and Clarke, 12 Fink et al, 16 and others, 13,17 have developed an algorithm for reducing admissions from this condition with particular reference to painful hips, most of which have a benign course.…”

mentioning

confidence: 99%

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The limping child: epidemiology, assessment and outcome

Fischer¹,

Beattie²

1999

The Journal of Bone and Joint Surgery

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We investigated the epidemiology, assessment and outcome of acute atraumatic limp in 243 children under the age of 14 years presenting to a paediatric accident and emergency department (AED) over a period of six months. Data were collected at presentation and medical notes were re-examined after 18 to 21 months. The incidence of limp was 1.8 per thousand. The male:female ratio was 1.7:1 and the median age 4.35 years. Limp was mainly right-sided (54%) and painful (80%); 33.7% of the children had localised pain in the hip. A preceding illness was found in 40%. The main diagnosis was 'irritable hip'/transient synovitis (39.5%); Perthes' disease accounted for 2%. Most patients (77%) were managed entirely in the AED. Acute atraumatic limp is a common problem in children presenting to the AED. Most can be safely managed there if guidelines are followed and will have a benign outcome. Further studies are needed to identify the role of preceding illness in the aetiology of acute atraumatic limp.

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Section: 913supporting

confidence: 57%

mentioning

confidence: 99%

The limping child: epidemiology, assessment and outcome

Fischer¹,

Beattie²

1999

The Journal of Bone and Joint Surgery

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“…Though occurring in patients with RA, the phenomenon described above is remarkably similar to an idiopathic syndrome reported in children and adults under the names of 'transient synovitis of the hip' and 'irritable hip', though not all of the synovial fluids from these cases have been inflammatory. [9][10][11] In our patients it must be assumed that the hip joint arthritis was a flare of the RA, and simultaneous flares in other joints in four of our five patients support this notion.…”

Section: Discussionsupporting

confidence: 49%

Acute non-infectious arthritis of the hip in patients with rheumatoid arthritis.

Halla¹,

Hardin²

1987

Annals of the Rheumatic Diseases

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“…The differentiation between septic arthritis and transient synovitis of the hip in children is essential, since the two clinical entities have different treatments and different potential for negative sequelae. Septic arthritis is treated with operative drainage and antibiotics, whereas transient synovitis is usually self-limited and is treated symptomatically 1,5,8,12,25,26,30 . Complications of septic arthritis include osteonecrosis, growth arrest, and sepsis, whereas transient synovitis usually has a benign clinical course 3,7,13,16,18,24,27,31 .…”

mentioning

confidence: 99%

Differentiating Between Septic Arthritis and Transient Synovitis of the Hip in Children

Kocher

Zurakowski

Kasser

1999

The Journal of Bone & Joint Surgery

546

351

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Background: A child who has an acutely irritable hip can pose a diagnostic challenge. The purposes of this study were to determine the diagnostic value of presenting variables for differentiating between septic arthritis and transient synovitis of the hip in children and to develop an evidence-based clinical prediction algorithm for this differentiation. Methods: We retrospectively reviewed the cases of children who were evaluated at a major tertiary-care children's hospital between 1979 and 1996 because of an acutely irritable hip. Diagnoses of true septic arthritis, presumed septic arthritis, and transient synovitis were explicitly defined on the basis of the white bloodcell count in the joint fluid, the results of cultures of joint fluid and blood, and the clinical course. Univariate analysis and multiple logistic regression analysis were used to compare groups. A probability algorithm for differentiation between septic arthritis and transient synovitis on the basis of independent multivariate predictors was constructed and tested. Results: Patients who had septic arthritis differed significantly (p < 0.05) from those who had transient synovitis with regard to the erythrocyte sedimentation rate, serum white blood-cell count and differential, weight-bearing status, history of fever, temperature, evidence of effusion on radiographs, history of chills, history of recent antibiotic use, hematocrit, and gender. Patients who had true septic arthritis differed significantly (p < 0.05) from those who had presumed septic arthritis with regard to history of recent antibiotic use, history of chills, temperature, erythrocyte sedimentation rate, history of fever, gender, and serum white blood-cell differential. Four independent multivariate clinical predictors were identified to differentiate between septic arthritis and transient synovitis: history of fever, non-weight-bearing, erythrocyte sedimentation rate of at least forty millimeters per hour, and serum white blood-cell count of more than 12,000 cells per cubic millimeter (12.0 x 10 9 cells per liter). The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized as less than 0.2 percent for zero predictors, 3.0 percent for one predictor, 40.0 percent for two predictors, 93.1 percent for three predictors, and 99.6 percent for four predictors. The chi-square test for trend and the area under the receiver operating characteristic curve indicated excellent diagnostic performance of this group of multivariate predictors in identifying septic arthritis. Conclusions: Although several variables differed significantly between the group that had septic arthritis and the group that had transient synovitis, substantial overlap in the intermediate ranges made differentiation difficult on the basis of individual variables alone. However, by combining variables, we were able to construct a set of independent multivariate predictors that, together, had excellent diagnostic performance in differentiating between s...

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The Irritable Hip Syndrome in Children:A Long-Term Follow-up

Cited by 38 publications

References 7 publications

The limping child: epidemiology, assessment and outcome

The limping child: epidemiology, assessment and outcome

Acute non-infectious arthritis of the hip in patients with rheumatoid arthritis.

Differentiating Between Septic Arthritis and Transient Synovitis of the Hip in Children

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