Highlights & Basics
- Transient synovitis of the hip is a self-limited inflammatory disorder of the hip that commonly affects young children between 2 and 12 years of age.
- The most important differential diagnosis to exclude is septic arthritis of the hip.
- More common in boys.
- Presents acutely with mild to moderate hip pain and limp.
- Treatment is supportive with activity restrictions and nonsteroidal anti-inflammatory drugs as needed.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Radiograph of a 5-year-old child with an irritable right hip showing subtle signs early in the disease process, such as capsular distention, joint space widening, and diminution of the definition of soft-tissue planes around the hip joint or slight demineralization of the bone of the proximal femur
Ultrasound of a hip documenting a hip effusion
Citations
Jain N, Sah M, Chakraverty J, et al. Radiological approach to a child with hip pain. Clin Radiol. 2013 Nov;68(11):1167-78.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: acutely limping child up to age 5. 2018 [internet publication].[Full Text]
Pediatric Orthopaedic Society of North America. Transient synovitis of the hip: study guide. [internet publication].[Full Text]
1. Cristaldi S, Boni A, Ferro V, et al. Atraumatic limping child, a challenge for pediatricians: an observational age-related study in a pediatric emergency department. Children (Basel). 2024 Feb 2;11(2):185.[Abstract][Full Text]
2. Krul M, van der Wouden JC, Schellevis FG, et al. Acute non-traumatic hip pathology in children: incidence and presentation in family practice. Fam Pract. 2010 Apr;27(2):166-70.[Abstract][Full Text]
3. Landin LA, Danielsson LG, Wattsgård C. Transient synovitis of the hip. Its incidence, epidemiology and relation to Perthes' disease. J Bone Joint Surg Br. 1987 Mar;69(2):238-42.[Abstract][Full Text]
4. Benoit J, El Khalifi S, Saoudi C, et al. Transient synovitis of the hip: development and validation of a new diagnostic algorithm. Acta Paediatr. 2024 Jun;113(6):1396-403.[Abstract][Full Text]
5. Quintos-Macasa AM, Serebro L, Menon Y. Transient synovitis of the hip in an adult. South Med J. 2006 Feb;99(2):184-5.[Abstract]
6. Vijlbrief AS, Bruijnzeels MA, van der Wouden JC, et al. Incidence and management of transient synovitis of the hip: a study in Dutch general practice. Br J Gen Pract. 1992 Oct;42(363):426-8.[Abstract][Full Text]
7. Uziel Y, Butbul-Aviel Y, Barash J, et al. Recurrent transient synovitis of the hip in childhood. Long-term outcome among 39 patients. J Rheumatol. 2006 Apr;33(4):810-1.[Abstract]
8. Kastrissianakis K, Beattie TF. Transient synovitis of the hip: more evidence for a viral aetiology. Eur J Emerg Med. 2010 Oct;17(5):270-3.[Abstract]
9. McCarthy JJ, Dormans JP, Kozin SH, et al. Musculoskeletal infections in children: basic treatment principles and recent advancements. Instr Course Lect. 2005;54:515-28.[Abstract]
10. Swarup I, LaValva S, Shah R, et al. Septic arthritis of the hip in children: a critical analysis review. JBJS Rev. 2020 Feb;8(2):e0103.[Abstract]
11. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999 Dec;81(12):1662-70.[Abstract]
12. Kocher MS, Mandiga R, Zurakowski D, et al. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 2004 Aug;86-A(8):1629-35.[Abstract]
13. Luhmann SJ, Jones A, Schootman M, et al. Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms. J Bone Joint Surg Am. 2004 May;86-A(5):956-62.[Abstract]
14. Caird MS, Flynn JM, Leung YL, et al. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. 2006 Jun;88(6):1251-7.[Abstract]
15. Jain N, Sah M, Chakraverty J, et al. Radiological approach to a child with hip pain. Clin Radiol. 2013 Nov;68(11):1167-78.[Abstract][Full Text]
16. American College of Radiology. ACR appropriateness criteria: acutely limping child up to age 5. 2018 [internet publication].[Full Text]
17. Pediatric Orthopaedic Society of North America. Transient synovitis of the hip: study guide. [internet publication].[Full Text]
18. Zamzam MM. The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children. J Pediatr Orthop B. 2006 Nov;15(6):418-22.[Abstract]
19. Kwack KS, Cho JH, Lee JH, et al. Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR Am J Roentgenol. 2007 Aug;189(2):437-45.[Abstract]
20. Yang WJ, Im SA, Lim GY, et al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol. 2006 Nov;36(11):1154-8.[Abstract]
21. American Academy of Pediatrics - Section on Orthopaedics and the Pediatric Orthopaedic Society of North America. Five things physicians and patients should question. Choosing Wisely, an initiative of the ABIM Foundation. 2018 [internet publication].[Full Text]
22. Kermond S, Fink M, Graham K, et al. A randomized clinical trial: should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs? Ann Emerg Med. 2002 Sep;40(3):294-9.[Abstract]
23. McNicol ED, Rowe E, Cooper TE. Ketorolac for postoperative pain in children. Cochrane Database Syst Rev. 2018 Jul 7;7(7):CD012294.[Abstract][Full Text]
24. Stone SB. Ketorolac in postoperative neonates and infants: a systematic review. J Pediatr Pharmacol Ther. 2021;26(3):240-7.[Abstract][Full Text]
25. Asche SS, van Rijn RM, Bessems JH, et al. What is the clinical course of transient synovitis in children: a systematic review of the literature. Chiropr Man Therap. 2013 Nov 14;21(1):39.[Abstract][Full Text]
26. Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br. 2008 Oct;90(10):1364-71.[Abstract]
