Table 1 Study characteristics
Source | No. TSa | Prospective/ Retrospective | Patient characteristics | Tests before diagnosing TSb | Age mean ± SD (range) | M/F ratio | Treatment | Follow-up period mean (range) |
|---|---|---|---|---|---|---|---|---|
Uziel 2006 [30] | 39 | Retrospective | Patients with at least 2 separate episodes of transient synovitis, at least 2 months apart, seen by pediatric rheumatologists. | - Lab: ESR, WCC, ANA, RF, FMF, HLA-B27 | 6 ± 2.6 years | 2:1 | 13 pt: NSAIDs, 5 pt: skin traction. | 4.2 ± 2.5 years |
- Plain radiographs of the hip, ultrasound, MRI, technetium bone scans | ||||||||
Skinner 2002 [3] | 25 | Prospective | Patients with TS with proven hip joint effusions detected on ultrasound, managed in the accident and emergency department as outpatients. The median duration prior to presentation was 2 days. | - History, full clinical examination, temperature | 6 (4–11) years | 4:1 | Rest at home, paracetamol. | 1–2 weeks |
- Lab: FBC, ESR | ||||||||
- Ultrasound, radiography of the hip | ||||||||
Kermond 2002 [18] | 36 | Prospective | Patients with clinical diagnosis of TS with a median duration of symptoms prior to presentation of 1 day. | - Clinical examination of the hip | 1–11 years | 4.1:1 | 17 pt. ibuprofen/paracetamol19 pt. placebo/paracetamol. | Time till symptom free |
- Lab: full blood examination, ESR, CRP | ||||||||
- Radiography of the hip in AP + frog leg lateral views | ||||||||
Fischer 1999 [4] | 65 | Prospective | Patients with a history of atraumatic limp who presented to a paediatric accident and emergency department either by self referral or from their general practitioner, with a median duration of symptoms of 1 day at presentation. | - History, full clinical examination, temperature | 4.35 yearsc | 1.7:1c | Unclear | 18–21 months |
- Lab: FBC, ESR | ||||||||
- Ultrasound, plain radiographs of the hip | ||||||||
Mattick 1999 [27] | 103 | Retrospective | Patient with hip pain or suspected hip pathology presenting to a Children’s Hospital. | - Range of movement of the hip, temperature | 0.9-15 years (median age of 5 years) | 3:1 | Rest at home. | 7 years |
- Lab: ESR, WBC | ||||||||
- Radiography of the hip | ||||||||
Eggl 1999 [12] | 106 hips | Prospective | Patients with hip pain and a preliminary diagnosis of TS referred to an outpatient clinic. | - History, clinical examination | 5.7 (1.8–10.1) years | 2.8:1 | Bed rest, positioning hip in flexion and oral application of naproxen. | 42 days |
- Lab: CRP, ESR, blood count, ASLO, electrophoresis | ||||||||
- Ultrasound | ||||||||
De Pellegrin 1997 [11] | 100 | Prospective | Patient with hip pain presenting to the orthopedic department with duration of symptoms prior to admission of 1 to 60 days. | - History | 4.14 ± 2.2 (1–10) years | 1.8:1 | Positioning hip in flexion/ abduction and external rotation and analgesics. | Unclear |
- Lab: full blood examination | ||||||||
- Ultrasound, scintigraphy, radiography of the hip, MRI | ||||||||
Kesteris 1996 [19] | 21 | Prospective | Patients with TS admitted to the Department of Orthopedics, treated in two consecutive groups. The mean duration of symptoms before admission was 2.6 days. | Unclear | 7.1 (4–12) years | 9.5:1 | 12 pt: arthrocentesis, | 6–12 months |
9 pt: no arthrocentesis | ||||||||
All children were kept in bed in the supine position with the hips in a few degrees of flexion. | ||||||||
Keenan 1996 [17] | 13 | Prospective | Children with a recurrent or prolonged irritable hip syndrome, defined as those with symptoms >1 month or in whom symptoms recurred within 1 month after initial resolution. | - Clinical examination of the hip | (4–8 years) | Not given | Restriction sporting activities, bed rest with positioning hip in flexion/abduction and external rotation. | 3 months |
- Radiography of the hip in Lauenstein + frog lateral views, ultrasound | ||||||||
Taylor 1995 [29] | 426 | Retrospective | Patients with an irritable hip admitted to hospital with a mean duration of symptoms before admission ranging from 3.7 to 4.9 days. | - History, temperature, range of movement | A: 5.7 years | A: 2.3:1 | Unclear | Unclear |
B: 2.4:1 | ||||||||
B: 6.6 years | C: 2:1 | |||||||
- Lab: FBC, ESR | ||||||||
C: 6.4 yearsd | ||||||||
- Radiography of the hip in AP + frog lateral views, bone isotope scans, MRI | ||||||||
Gopakumar 1992 [2] | 181 | Retrospective | Patients with suspected irritable hip syndrome admitted to hospital with a mean duration of symptoms prior to presentation of 3 days. | - Clinical examination of the hip | 7 (0.9–14) years | 2:1 | Bed rest followed by early mobilization. | 7 (6–24) months |
- Lab: WBC, ESR | ||||||||
- Radiography of the hip in AP, ultrasound, bone isotope scan | ||||||||
Terjesen 1991 [22] | 58 | Prospective | Patients with TS treated in the Department of Orthopedic Surgery with a mean duration of symptoms prior to admission of 3 days. | - Ultrasound, radiography of the hip in AP | 5.8 (2–15) years | 3.1:1 | Bed rest, bilateral skin traction and moderate flexion of the hip. | 11 (6–26) weeks |
Briggs 1990 [23] | 286 | Retrospective | Children with TS presented to a Children’s Hospital. | - Clinical examination | (2–13 years) | 2:1 | Bed rest with or without traction applied to the affected leg with the hip in extension. | Unclear |
- Lab: FBC, ESR, serum urea, electrolyte estimations, bacteriological investigations: by throat swabs, urine cultures and blood cultures, agglutinins against Salmonella, brucellosis, viral antibodies, Paul Beunnell test, RA Latex and Rose-Waaler titers, antinuclear factor, Tine test or Mantoux test. | ||||||||
- Radiography of the hip in AP and Lauenstein views | ||||||||
Hasegawa 1988 [14] | 55 | Prospective | Children with the clinical diagnosis TS admitted for examination at hospital, with duration of symptoms prior to examination of 18 days. | - Range of movement | 7 (2–13) years | 2.4:1 | Unclear | 4–9 months |
- Radiography of the hip in AP + Lauenstein views | ||||||||
Kallio 1988 [16] | 109 | Prospective | Children with TS admitted to hospital, with duration of symptoms prior to admission of 3 days in 75% of the cases. | - Clinical examination | 5.6 years | 2:1 | Unclear | 1 year |
- Hematologic and serologic examinations, bacterial cultures from the throat, blood, urine and synovial fluid | ||||||||
- Radiography of the hip in AP + Lauenstein views, ultrasound, hip aspiration with intraarticular pressure | ||||||||
Landin 1987 [1] | 275 | Retrospective | Children with TS admitted to hospital or treated as outpatients with a 1 to 7 day history of symptoms prior to treatment. | - Range of movement, temperature | (1–13 years) | 2.6:1 | Skin traction with the affected hip placed in extension and/or bed rest. | 3 months–9 years |
- Lab: Hb, WBC, antistreptolysin, CRP, antibodies against Yersinia enterocolitica and Shigella, bacterial cultures from throat swab and urine | ||||||||
- Radiography of the hip in AP + frog lateral views | ||||||||
Egund 1987 [13] | 70 | Prospective | Children with TS admitted to the Department of Diagnostic Radiology and Orthopedics. | - History, clinical findings | 6 (1–12) years | 2.7:1 | Unclear | 6.5 (5–9) months |
- Radiography of the hip in AP + Lauenstein, CT, ultrasound | ||||||||
Kallio 1986 [15] | 119 | Prospective | Children with TS seen at a Children’s Hospital. | - Clinical examination | Not given | Not given | Bed rest. | 1 year |
- Hematology, serology and bacterial culture from throat, blood, urine and synovial fluid | ||||||||
- Radiography of the hip in AP + Lauenstein views, ultrasound, hip aspiration | ||||||||
Haueisen 1986 [24] | 475 | Retrospective | Children with TS who have been hospitalized. | - Physical examination, temperature | 6.2 (0.8–18) years | 2.2:1 | Bed rest, Buck’s traction, antibiotics, spica casting. | 6 months–4 years |
- Lab: RF, ANA, WBC, ESR | ||||||||
- Radiography of the hip, hip aspiration | ||||||||
Mukamel 1985 [20] | 41 | Prospective | Children with TS followed as outpatients. | - History, physical examination | Average of 3.8 (1.3–12.5) years | 3:1 | Bed rest and analgesics. | 9.3 months (3 months–3 years) |
- Lab: ESR, WBC | ||||||||
- Radiography of the hip | ||||||||
Illingworth 1983 [25] | 54 | Retrospective | Children with a first episode of TS or with a recurrence of TS who attended hospital. | - Range of hip movement | 6.4 (2–12) years | 4.4:1 | Unclear | Unclear |
- Lab: ESR, WBC, CRP, ASO, RF, bacterial culture from throat and stool, monospot test for infectious mononucleoisis | ||||||||
- Radiography of the hip | ||||||||
Sharwood 1981 [28] | 101 | Retrospective | Children with TS admitted to a Children’s Hospital with a period of symptoms prior to admission <7 days in 82% of the cases. | - Clinical examination of the gait, range of hip movement and leg length | 5.6 | Unclear | Unclear | Average of 8.2 (5–15) years |
- Lab: ESR, WBC | ||||||||
- Radiography of the hips in AP + frog lateral positions. | ||||||||
Calver 1981 [10] | 50 | Prospective | Children with TS presented at a Children’s Hospital with a mean duration of symptoms prior to admission of 4.5 days. | - Range of hip movement | 6.1 (3–12) years | 2:1 | Bed rest and skin traction followed by slow mobilization. | 1 year |
- Lab: blood count, blood film, ESR, RA latex agglutination, Widal and anti-staphylococcal titre, bacterial cultures from the throat and urine | ||||||||
- Radiography of the hip in AP + frog lateral views, radioisotope scans. | ||||||||
Mallet 1981 [26] | 38 | Retrospective | Children admitted to hospital, with duration of symptoms prior to admission between 0 and 45 days. | - Radiography of the hip | 6 (2–13) years | 1.1:1 | Skin traction, plaster. | 7 (2–20) years |
Stock 1977 [21] | 34 | Prospective | Children treated for TS at the Orthopedic Department, with duration of symptoms prior to admission mostly less than 1 week. | - History, physical examination | 7.9 (4–14) years | 1.6:1 | Bed rest, relievement of hip, antibiotics, plaster, Tanderil, remedial therapy. | 4.3 (0.5–15) years |
- Lab: WBC, AST, CRP | ||||||||
- Radiography of the hip |