Intracapsular pressure in transient synovitis of the hip

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 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 of flexion to reduce intracapsular pressure. Forcing the hip in extension causes a risk of ischaemia of the PFE.