Orthopedics - Oleksa A.P. 2006

Joint Diseases
Arthritis of Undetermined Etiology
"Migratory" (Transient) Coxitis

A painful hip joint is a fairly common Clinical presentation with a diverse Etiology. Among various pain syndromes characterized by distinct clinical and radiological features that present no diagnostic challenge, transient synovitis of the hip (coxitis infantilis fugax) in children is frequently a source of misdiagnosis, particularly during the Cytology/cytology/16.html">Early stages of the disease.

"Transient coxit" is an inflammatory process of unknown etiology (Kiepurska et al., 1973; Bernd et al., 1992) that predominantly affects children of both sexes, although Bogdan et al. (1998) note a higher incidence in boys. Typically, children aged 2 to 17 years are affected, with 83% of cases occurring in children between 3 and 10 years of age. The condition is generally considered self-limiting, with a relatively short course and no significant sequelae, although Walderrama (1991) suggests it may predispose to premature degenerative joint changes. The most common presenting Complaints are hip pain (72%) or pain referred to the knee, which frequently misleads the clinician.

As a rule, patients are admitted to the inpatient department a week or more after the onset of initial symptoms, following outpatient consultation and Treatment. Some patients attribute the onset of the disease to trauma (Kiepurska et al., 1972; Kotban et al., 1991), and allergy is identified in 5% of cases; however, in 30–50% of patients, transient coxit develops following an Upper Respiratory Tract infection occurring a week to a month prior to the onset of hip pain (Koszla, 1968; Bernd et al., 1992; Napiontek et al., 1998).

The predominant clinical manifestations are hip pain and antalgic gait (limping). Initial Clinical examination of all children initially reveals a loss of the physiological hyperextension of the hip, followed by a variable degree of protective antalgic flexion contracture. Most patients exhibit restricted rotational mobility in the joint, particularly internal rotation.

Laboratory findings show only a mild elevation in WHITE Blood Cell count, serum mucoids, and ERYTHROCYTE SEDIMENTATION RATE (ESR) in a minority of children. Studies have established the presence of non-specific synovial inflammation accompanied by intra-articular exudate accumulation.

To establish a definitive Diagnosis, Ultrasonography, plain radiography, and computed tomography are employed.

Transient coxit (coxitis fugax) must be differentiated from Legg-Calvé-Perthes disease, routine infectious or tuberculous coxitis, Slipped capital femoral epiphysis (SCFE), and neoplastic processes.

In the diagnosis of osteochondropathy (Perthes disease) and slipped capital femoral epiphysis, plain radiography—particularly in the lateral projection—is essential for detecting early-stage disease. Normal laboratory parameters, alongside synovial fluid sterility, rule out an infectious inflammatory process.

According to the literature (Carty et al., 1984; Gopakumar et al., 1992), scintigraphy also serves as a diagnostic standard that facilitates Differential diagnosis and guides therapeutic management.

However, established diagnostic algorithms are not universally applicable due to the lack of necessary equipment (Taylor & Clarke, 1994; Berman, Edwards & Jacobson, 1995).

Consequently, such children are hospitalized to clarify the diagnosis using available modalities and to initiate appropriate treatment.

In cases of pronounced pain and joint contracture, bed rest with Skin traction of the affected limb, analgesics, and desensitizing therapy are prescribed. Inflammatory signs typically subside within 8–10 days.

If foci of infection are identified (such as dental caries or upper respiratory tract catarrh), sanitation and even antibacterial therapy are administered. Once pain subsides, physical therapy and balneotherapy are initiated. The application of paraffin-ozokerite compresses improves local Blood Circulation in the joint, facilitates the resorption of exudate and resolution of contracture, and restores joint function.

Following discharge from the hospital, children should remain under outpatient dispensary surveillance with periodic orthopedic evaluations. If necessary, follow-up radiography of the hip joint should be performed after three to four months.