Coxitis fugax (synonyms: coxalgia fugax, hip flare, or transient synovitis) primarily affects children. In most cases, the condition resolves on its own after a few days. Consistent rest can relieve symptoms.
What is coxitis fugax?
Coxitis fugax is also referred to as hip flare-ups, among other names. In this context, coxitis fugax describes an inflammation of the hip joint that is not due to germs. Hip fugax frequently occurs in children between the ages of four and ten; boys are more frequently affected by the disease than girls. Typical symptoms of coxitis fugax include sudden hip pain that can radiate to the knee. In order to spare the affected knee, patients often show a temporary limp. Frequently, in the presence of coxitis fugax, movement restrictions of the hip are also observed; turning the leg with the help of the hip joint in particular proves to be painful in this case.
Causes
In medicine, the exact causes of coxitis fugax are largely unclear. However, it is known that coxitis fugax was usually preceded by a viral infection that affected, for example, the upper respiratory tract (such as the nose and/or sinuses) or the gastrointestinal tract. In most cases of coxitis fugax, a time window of about two weeks is given between the resolution of a viral infection and the appearance of the first symptoms of hip flare. It is therefore assumed by medical experts that coxitis fugax is not a disease in its own right, but rather the consequence of a viral infection.
Symptoms, complaints, and signs
In most cases, coxitis fugax does not cause permanent damage or other complications. The disease heals thereby mostly again by itself, so that also a treatment is not always necessary. First and foremost, those affected by coxitis fugax suffer from very severe pain in the hip. This pain leads to movement restrictions and also to gait disorders, so that the affected children limp or walk with a limp. This also significantly restricts and slows down the child’s development, as the children are unable to participate in various activities. These limitations can also lead to psychological upsets or depression, which are particularly aggravated by bullying or teasing. In general, coxitis fugax has a very negative effect on the quality of life of the affected person and reduces it. In some cases, permanent damage can also occur due to further misuse, although this is relatively rare. In severe cases, the children are dependent on a walking aid and the help of other people in their daily lives. In this case, crutches may be necessary, for example, so that the joint does not continue to be heavily loaded. The patient’s life expectancy is not negatively affected by coxitis fugax.
Diagnosis and course
The suspected diagnosis of coxitis fugax may initially be made on the basis of a patient’s typical complaints (such as sudden hip pain and the appearance of a limp). Since affected patients are usually children, ultrasound is particularly suitable for checking the tentative diagnosis. If ultrasound reveals a widened joint space filled with fluid, this usually indicates the presence of coxitis fugax. Advantages of the ultrasound procedure for diagnosing coxitis fugax are (especially in children) that the procedure is not painful and does not cause radiation exposure. It is also possible to detect acute inflammatory processes in the body during blood sampling; if the blood count of an affected person does not show any abnormalities in this regard, coxitis fugax may still be present. Coxitis fugax often resolves itself after one to two weeks. If hip pain is present beyond this time period, a patient probably does not have coxitis fugax but another disease or functional impairment.
Complications
In most cases, coxitis fugax does not result in further symptoms or complications. If the affected child complies with bed rest and is able to relax, the condition resolves on its own. As a rule, the patient experiences short-term restrictions in mobility. In particular, the hip hurts and gait disturbances occur, which can become noticeable by limping.The patient’s quality of life is limited and reduced by coxitis fugax. In most cases, the fluid itself disappears after about two weeks and does not cause further discomfort. The affected person may be dependent on taking painkillers during this time. Above all, bed rest and sparing the body have a positive effect on the disease. It is not uncommon for children to require crutches for movement. If coxitis fugax does not disappear on its own, medication is used. This also does not lead to further complications. In severe cases, the fluid can also be removed directly by a doctor so that the joint is relieved. No subsequent damage occurs.
When should you go to the doctor?
Coxitis fugax, also known as hip flare, mainly affects children between the ages of four and ten. The disorder very often resolves on its own after about ten to fourteen days. Provided the hip rhinitis is clearly identified, doctors often do not take countermeasures immediately, but wait for the disease to progress first. Parents of affected children should nevertheless consult a doctor as a precaution if their child shows symptoms that point to hip rhinitis. Sudden hip pain, which often radiates to the knees, is characteristic. To relieve pressure on the affected leg, children then begin to limp. Very often, coxitis fugax is accompanied by additional symptoms, especially movement restrictions of the hip. Rotations of the hip joint are often perceived by the children as painful. At the latest then the family doctor or a pediatrician should be consulted. Although the disease is not treated causally, the doctor can at least prescribe painkillers. In addition, a correct diagnosis is important, because in the case of hip rhinitis, it is extremely important that patients take it easy and, if possible, stay in bed.
Treatment and therapy
Once coxitis fugax has been clearly diagnosed and no concomitant diseases are present in an affected individual, the inflammation is often treated with a wait-and-see approach; this means that the course of the disease and any improvements that occur are initially observed. During coxitis fugax, physicians also recommend consistent physical rest. Such rest can be achieved, for example, by a few days of bed rest. The hip can also be spared in the presence of coxitis fugax by using walking aids (colloquially: crutches) when walking during the acute illness. In addition, the hip can be relieved in coxitis fugax by a so-called extension. This involves stretching the legs, which results in a slight pull on the hip joint. This traction in turn helps to relieve the hip. Depending on the severity of the symptoms of coxitis fugax, medications may be prescribed to reduce pain or inflammation. If the joint space of the hip joint is filled with a large amount of fluid in an affected patient, it may be useful to puncture the hip joint in individual cases. Puncture for coxitis fugax allows the fluid to drain out of the joint, resulting in relief of the joint.
Outlook and prognosis
Coxitis fugax usually lasts only a few days. About half of all patients can be discharged from treatment as healthy after one week. The disease has a very good prognosis and results in the patient being free of symptoms after two weeks at the latest. There is a complete recovery, which is permanent and therefore without a risk of recurrence of symptoms. The healing process can be shortened by consistent rest and sufficient rest. In coxitis fugax, the body’s natural self-healing powers are activated. The patient’s behavior is also partly responsible for a quick healing. Medical care is not absolutely necessary. If the doctor’s advice and instructions are followed, the patient can recover without the administration of medication. Further complications are not to be expected in normal cases. The motor impairments are short-lived. Therefore, there is a rapid improvement in the quality of life and an increase in well-being. In the event of severe pain, painkillers may be taken. These are associated with numerous risks and side effects. There may be sequelae that lead to a deterioration of health.Under normal conditions, remission of side effects occurs with discontinuation of the drug.
Prevention
It is difficult to prevent the occurrence of coxitis fugax. However, a painful exacerbation of symptoms when coxitis fugax is already present can be prevented by closely observing initial symptoms. Thus, rapid diagnosis and fast-acting sparing can positively influence the course of symptoms.
Aftercare
Even though coxitis fugax is a self-limiting disease usually without permanent damage, follow-up care should be emphasized, especially a short time after the acute phase. Particularly in the case of a prolonged course in which no improvement in symptoms has been observed after six to ten days, the physician should be consulted again. Here, the CRP, which allows the level of inflammation in the body to be estimated, and a blood count should be ordered. In addition, hip ultrasonography should be performed to assess the joint effusion and its regression after the end of the disease. Differential diagnoses such as Perthes disease or coxitis of bacterial origin should also always be reevaluated if symptoms persist for a long time or recur during follow-up. Normally, however, only a short period of rest and relief of the joint is necessary. After this, patients should, in consultation with the treating physician, return to full weight-bearing of the joint and ensure sufficient exercise and sporting activity. If the resting phase lasts too long, incorrect postures and relieving postures can become ingrained and lead to joint and muscle problems occurring later. Depending on the individual situation, it is advisable to take another X-ray after about three to four months in order to evaluate the joint space. This should be discussed with the physician.
What you can do yourself
It is especially important for children to have a strong immune system. Since this must first develop during life, it helps if it is supported by a vitamin-rich diet, protected clothing and sufficient exercise in the fresh air. A one-sided and fatty diet should be avoided. Varied and high-fiber meals help to protect the organism against viruses or to support the immune system in building up its defenses. At the first signs of a viral infection, the child should avoid cold as well as places where there are many pathogens. In the case of coxitis fugax, it also helps if incorrect postures of the body are well observed and corrected by the parents. If abnormalities appear, the advice of a doctor should be sought. As soon as the child puts one-sided strain on the bones or joints or overstrains them, loving tips and advice can be used to encourage the child to improve his or her posture. Sports activities help to build up the muscles. Sitting, standing or running for too long should be avoided. Likewise, care should be taken not to carry too much weight from the child. Depending on stature and physique, children have very different weight-bearing capacities and the skeletal system is susceptible to damage.