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(Radiology. 1999;210:499-507.)
© RSNA, 1999

Pediatric Imaging

Anterior Joint Capsule of the Normal Hip and in Children with Transient Synovitis: US Study with Anatomic and Histologic Correlation

Simon G. F. Robben, MD1, Maarten H. Lequin, MD1, Ad F. M. Diepstraten, MD2, Jan C. den Hollander, MD3, Cees A. C. Entius4 and Morteza Meradji, MD1

1 Departments of Pediatric Radiology (S.G.F.R., M.H.L., M.M.)
2 Pediatric Orthopedic Surgery (A.F.M.D.), Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands
3 Departments of Pathology (J.C.d.H.)
4 Anatomy (C.A.C.E.), Erasmus University, Rotterdam, the Netherlands.

PURPOSE: To study the anatomic components of the anterior joint capsule of the normal hip and in children with transient synovitis.

MATERIALS AND METHODS: Six cadaveric specimens were imaged with ultrasonography (US) with special attention to the anterior joint capsule. Subsequently, two specimens were analyzed histologically. These anatomic findings were correlated with the US findings in 58 healthy children and 105 children with unilateral transient synovitis.

RESULTS: The anterior joint capsule comprises an anterior and posterior layer, mainly composed of fibrous tissue, lined by only a minute synovial membrane. Both fibrous layers were identified separately at US in 98 of 116 (84%) hips of healthy subjects and in all hips with transient synovitis. Overall, the anterior layer was thicker than the posterior layer. In transient synovitis compared with normal hips, no significant thickening of both layers was present (P = .24 and .57 for the anterior and posterior layers, respectively). Normal variants include plicae, local thickening of the capsule, and pseudodiverticula.

CONCLUSION: Increased thickness of the anterior joint capsule in transient synovitis is caused entirely by effusion. There is no US evidence for additional capsule swelling or synovial hypertrophy.

Index terms: Hip, anatomy, 44.92 • Hip, infection, 44.26 • Ultrasound (US), guidance, 44.12986




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