Intracapsular pressure in transient synovitis of the hip

Abstract

Fourteen consecutive children with symptoms of transient synovitis of the hip were examined with sonography regarding intracapsular effusion, with scintimetry regarding blood-flow in the proximal femoral epiphysis (PFE) and with intracapsular pressure recording and aspiration. All patients had an intracapsular effusion. Intracapsular pressure was found to depend on the position of the hip. The mean pressure with hips in extension and inward rotation was 22.6 kPa (170 mm Hg) whereas in 45 degrees of flexion it was 2.3 kPa. In two cases scintimetry demonstrated reduced blood flow to the PFE; after aspiration, isotope uptake returned to normal, indicating that increased intracapsular pressure has a harmful effect on circulation to the PFE. Children with transient synovitis should be treated with the hips in 45 degrees of flexion to reduce intracapsular pressure. Forcing the hip in extension causes a risk of ischaemia of the PFE.

Septic Arthritis Versus Transient Synovitis of the Hip: Gadolinium-Enhanced MRI Finding of Decreased Perfusion at the Femoral Epiphysis

“…We postulate that there is a relation between the decreased signal intensity with enhancement at the femoral epiphysis that we observed and perfusion of the femoral head. Kesteris et al [29] and Wingstrand et al [30] reported the significance of increased intracapsular pressure related to hip joint effusion in patients with transient synovitis.…”

“…We recommend performing MRI before arthrocentesis in patients with irritable hip because reports [21,29,30] suggest that intracapsular pressure, effusion, and impaired perfusion of the hip are related to one another. Caird et al [18] and Luhmann et al [2] isolated various organisms from cultures of patients with confirmed septic arthritis of the hip.…”

Computed tomography and ultrasonography for diagnosis of hip joint effusion in children

“…The tension of the hip capsule is increased in extension and internal rotation and especially in hips with effusion (Wingstrand et al 1985b) -a condition that may result in an altered distribution of the fluid within the joint. This may exaplain the slight discrepancy between US and CT measurements obtained in those hips with the largest effusion, because the reproducibility of hip flexion and rotation between the two examinations was less accurate in the patients with the most pain.…”

“…Experimentally and clinically increased intracapsular pressures have been shown to produce ischemia of the proximal femoral ephiphysis (Woodhouse 1964, Lucht et al 1983, Kloiber et al 1983, Wingstrand et al 1985b.…”

Sonography, arthroscopy, and intracapsular pressure in juvenile chronic arthritis of the hip

“…A two-plane image intensifier was used. The joint capsule was punctured with a 1.2 mm epidural needle connected via a tube with heparinized saline to a piezoelectric pressure transducer (Wingstrand et al 1985). The joint pressure was recorded immediately after puncture of the joint in neutral extension, in maximal inward and outward rotation in extension, and at 45 degrees of neutral flexion.…”