The patient was a 50-year-old female with a history of left hip strain one year ago. Later, she suffered from pain and discomfort in the left hip joint after exercising with cold, which affected her walking. She consulted several specialists at Jishuitan, Beihang Hospital, Peking University Hospital, People’s Hospital and China-Japan Hospital. Half of the specialists thought it was femoral head necrosis and half thought it was traumatic synovitis. However, most of the western specialists said that surgery was needed. Later, he came to my clinic. The MRI of the hip joint showed no obvious necrotic changes in the femoral head, slightly sparse bone trabeculae, and significant thickening of synovial shadow. It was considered that synovitis of the hip joint was more likely. The patient came to the clinic on crutches and was advised to undergo conservative treatment for half a year to see the effect, and then surgery if it did not work. After six months of acupuncture, manipulation and drug ionization, the patient’s left hip pain was significantly relieved, and walking was basically unrestricted, and he was no longer on crutches. Now the long-term conservative treatment, the effect is good. After this case, when I met similar cases in the clinic, I told the patient to consult several doctors and not to make a hasty decision of surgery. Of course, in order to be practical, evidence-based treatment, specific analysis of the specific situation, the operation of the operation, can be conservative first conservative try. Synovitis of the hip joint Synovitis of the hip joint is also called transient synovitis of the hip joint, and children under 3-10 years old are prone to synovitis of the hip joint. The peak incidence is between 3 and 6 years of age, with more right-sided than left-sided cases and 5% of bilateral hip incidences. Synovitis of the hip joint? Synovitis of the hip joint, also known as transient synovitis, is a multiple disease that affects children under the age of 3 to 10 years, most of whom are male and most of whom have a sudden onset. The peak incidence is between 3 and 6 years of age, with more right-sided than left-sided cases and 5% of bilateral hip incidences. The causes may be related to viral infections, trauma, bacterial infections and allergic reactions (allergic reactions). The onset is either acute or slow. The child reports pain in the front or side of the thigh and knee, pain-avoidance gait, tenderness in the front of the hip joint, limited range of motion and discomfort. The peripheral blood leukocyte count and sedimentation are normal. Tuberculin skin test, rheumatoid factor titer, and anti-streptococcal hemolysin antibody titer are usually negative. Radiology of the hip joint is normal or there is a small amount of joint effusion. There are no bony changes in this disease. Transient hip synovitis should be treated with bed rest and topical anti-inflammatory medication until the pain in the hip disappears and the range of motion returns to normal (3 to 7 days). Some doctors recommend resting for a period of time (7-10 days) after the symptoms have disappeared. Bed rest is difficult because of the child’s mobility, but ways should be found to try to do so. Antibiotics can be taken in small amounts and corticosteroids are not advocated. According to Chinese medicine, this disease is caused by external evil, joint injury, acupuncture point obstruction, fluid accumulation, can be applied externally through the membrane to eliminate pain. Synovitis can be cured by applying a combination of internal and external treatment to repair the synovial membrane. Treatment and rehabilitation Children diagnosed with transient hip synovitis should be followed up by a doctor at 2 weeks after the onset of the disease and be clinically evaluated. A clinical examination should be done again at 2 and 6 months after the first onset, if necessary. Synovitis is a joint lesion caused by an injury to the joint and irritation of the synovial membrane, resulting in an imbalance in synovial fluid secretion and fluid accumulation. To add to this, the affected limb must be immobilized and activity reduced. Medication is more effective when applied externally using traditional Chinese medicine. Synovial membrane is mainly distributed around the joints. It is connected to the joint cavity and secretes lubricating fluid to lubricate the joint. The synovial membrane reacts to inflammation by stimulation or direct stimulation from various causes, and the synovial membrane reacts to inflammation by secreting exudate. Strictly speaking, as long as there is exudate in the joint, it proves the existence of synovial inflammation, whose main manifestations are joint congestion and swelling, pain, increased exudate, joint effusion, difficulty in moving and squatting, and functional limitation. Synovitis is a sterile inflammation caused by poor microcirculation, and the main symptom is the production of fluid. The production and absorption of joint fluid is a “dynamic balance”. When the reabsorption of joint fluid is impaired, the dynamic balance between the production and absorption of joint fluid is broken, and the production of joint fluid is greater than the reabsorption, then “joint effusion” will occur. Therefore, the main treatment of synovitis is to regulate the microcirculatory system, as long as the microcirculation is smooth, the fluid will disappear, and the inflammation will also be lifted, try not to exert yourself during the period of fluid accumulation, reduce the frequency of pumping injections, too much pumping injections will stimulate the subsynovial connective tissue group fiber proliferation, as well as synovial tissue aging, so that the regeneration and repair ability of synovial tissue is significantly reduced, and then the treatment will be more troublesome. Difference with femoral head necrosis In terms of clinical diagnosis, hip synovitis is easily confused with femoral head necrosis, and the symptoms of both are similar, which is more likely to cause misdiagnosis. The following differences exist between hip synovitis and femoral head necrosis: 1, hip synovitis is more common in children under the age of 3 to 10, with males being more common, with peak incidence of 3 to 6 years old, more on the right than on the left, and 5% of bilateral hip incidence; while ischemic necrosis of the femoral head is more common in adults aged 30 to 50, with males being the majority. 2, the cause of hip synovitis may be related to viral infection, trauma, bacterial infection and allergic reaction (allergic reaction ); while ischemic necrosis of the femoral head is aseptic necrosis, is due to trauma, hormones. Alcohol, wind, cold and dampness, overexertion and other factors caused by their own ischemic necrosis. 3, hip synovitis in CT, MRI examination is normal or there is a small amount of joint effusion; while femoral head necrosis through CT observation can be found in multiple lamellar hypointense shadow and cystic translucent area or hip joint cavity narrowing, acetabular outer edge hyperplasia, acetabular bone sclerosis or cystic changes. Treatment session notes Synovitis is a joint lesion in which the synovial membrane is stimulated to produce inflammation, resulting in the imbalance of secretion to form a fluid, which has long affected the normal life of patients, work, bringing a lot of trouble, some patients seek medical help around, repeated episodes, painful, and even psychologically overshadowed, synovitis is an incurable disease, so synovitis can be completely cured, we believe that attention to three links The first one is to make a clear diagnosis in time; 2, timely and effective comprehensive treatment; 3, timely functional exercise, good daily health care, one of these three links is indispensable. Hip synovitis life conditioning (1) avoid long-term strenuous exercise Long-term, excessive, strenuous exercise or activity is one of the basic causes of synovial degeneration. Especially for weight-bearing joints (such as knee joints, hip joints), excessive exercise increases the force on the joint surface and increases wear and tear. Long-term strenuous exercise can also cause excessive stress and strain on the bones and surrounding soft tissues, resulting in local soft tissue damage and uneven stress on the bone and ilium, which can lead to osteophytes. (2) Appropriate physical exercise Avoiding long-term strenuous exercise is not inactivity, on the contrary, appropriate physical exercise is one of the good ways to prevent osteophytes. Because the nutrition of joint cartilage comes from the joint fluid, and the joint fluid can only enter the cartilage by “squeezing” to promote the metabolism of cartilage. Proper exercise, especially joint exercise, can increase the pressure in the joint cavity, which is conducive to the penetration of joint fluid into the cartilage and reduce the degenerative changes in the articular cartilage, thus reducing or preventing synovitis, especially the hyperplasia and degenerative changes in the articular cartilage. (3) Timely treatment of joint injuries Joint injuries include soft tissue injuries and bone injuries. Osteomalacia of joints is often directly related to intra-articular fractures. Traumatic arthritis occurs due to incomplete fracture repositioning, resulting in uneven articular cartilage surfaces. For patients with intra-articular fractures, if timely treatment and anatomical repositioning can be done, traumatic arthritis and joint osteophytes can be completely avoided. (4) Reduce body weight Excess weight is one of the major causes of spinal and joint osteophytes. Excess weight accelerates the wear and tear of joint cartilage, causing uneven pressure on the cartilage surface of the joint and causing synovial inflammation. Therefore, for people who are overweight, proper weight loss can prevent spine and joint synovitis. Hip synovitis precautions 1, synovitis patient’s room should be sunny, warm and cold to prevent dampness. Pay attention to weather changes, avoid dampness and cold, the lesioned joint should be protected by a sheath. 2, to exercise regularly and correctly, to maintain a normal weight, to avoid obesity. 3, to prevent excessive fatigue, the acute period should be appropriate rest, reduce activity, keep the joints in a functional position, but in the subacute or remission period, you can carry out joint functional exercise, physical care, to prevent muscle atrophy, joint ankylosis, to maintain the best function of the joint. 4, to change the excessive drinking and other bad habits, pay attention to a reasonable diet. In the diet should increase nutrition, supplement sufficient protein and multivitamins, in addition to taking food containing more calcium, such as milk, soy products, etc.. Food should be easy to digest. Avoid stimulating, cold and hard foods. Food should be nutritious and tasty to enhance appetite.