Septic arthritis of the hip (peds): Difference between revisions
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==Background== | ==Background== | ||
{{Hip anatomy background images}} | |||
*Age - 6 mo to 8 yrs | *Age - 6 mo to 8 yrs | ||
*Hematogenous spread or local infection | *Hematogenous spread or local infection | ||
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==Clinical Features== | ==Clinical Features== | ||
*Pain, | *[[Hip pain (peds)|Pain]], pseudoparalysis | ||
*May present with referred knee or thigh pain | *May present with referred knee or thigh pain | ||
*Usually hold joint in flexion, external rotation and slight abduction | *Usually hold joint in flexion, external rotation and slight abduction | ||
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**possible effusion | **possible effusion | ||
*Consider: | *Consider: | ||
**Ultrasound to evaluate for effusion | **[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion | ||
**CT to evaluate for abscess | **CT to evaluate for [[abscess]] | ||
{{Kocher criteria}} | {{Kocher criteria}} | ||
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[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:ID]] | |||
Latest revision as of 20:25, 26 February 2025
Background
- Age - 6 mo to 8 yrs
- Hematogenous spread or local infection
- Staph, S. Pneumo, group A strep
- Neonates: also Group B strep and gram negatives
Clinical Features
- Pain, pseudoparalysis
- May present with referred knee or thigh pain
- Usually hold joint in flexion, external rotation and slight abduction
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Evaluation
Workup
- Labs - ESR >20, WBC >12
- Blood cultures (40-50% grow out)
- Xrays
- useful to exclude other cause of joint pain (AP & Frog leg)
- possible effusion
- Consider:
- Ultrasound to evaluate for effusion
- CT to evaluate for abscess
Kocher Criteria for septic arthritis of the hip
- ESR > 40 mm/hr
- WBC > 12,000/microliter
- Refusal or inability to weight bear on affected joint
- Fever 38.5° C or greater
| Number of Kocher Criteria | Chance of Septic Joint |
| 1 | 3% |
| 2 | 40% |
| 3 | 93% |
| 4 | 99% |
Management
- OR drainage
- IV antibiotics x 10-14 days (before po)
- Oxacillin, Nafcillin or Clindamycin in penicillin allergic
- Cover Haemophilus influenzae as needed with 3rd generation cephalosporin
Disposition
- Admit