Septic arthritis of the hip (peds): Difference between revisions

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==Background==
==Background==
*hematogenous spread or local inf.
{{Hip anatomy background images}}
* wt. bearing joints most common
*Age - 6 mo to 8 yrs
* knee (40-50%)
*Hematogenous spread or local infection
* hip (20- 25%)
*[[Staph]], [[S. Pneumo]], [[group A strep]]
* staph, S. Pneumo, group A strep
*Neonates: also [[Group B strep]] and [[gram negatives]]
* in neonates also Groub B strep % gram neg.
 
==Clinical Features==
*[[Hip pain (peds)|Pain]], pseudoparalysis
*May present with referred knee or thigh pain
*Usually hold joint in flexion, external rotation and slight abduction


==DDX==
==Differential Diagnosis==
[[Hip Pain (Peds)]]
{{Pediatric hip DDX}}


==Diagnosis==
==Evaluation==
*Age - 6 mo to 8 yrs
===Workup===
*Pres - Pain, Pseudoparalysis
*Labs - ESR >20, WBC >12
*Labs - ESR > 20 after 1-2 d, WBC >
*Blood cultures (40-50% grow out)
*Xrays - possible effusion
*Xrays  
**useful to exclude other cause of joint pain (AP & Frog leg)
**possible effusion
*Consider:
**[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion
**CT to evaluate for [[abscess]]


* may present w/ referred knee or thigh pain
{{Kocher criteria}}
* usually hold jt in flexion, ext rotat & slt abduction.
* get Bld Cxs (40-50% grow out)
* Xrays useful to exclude other cause of joint pain (AP & Frog leg)
* CT may be useful to look for abscess, UTZ for effusion.


===Kocher Criteria===
==Management==
#ESR > 40
*OR drainage
#WBC > 12
*IV [[antibiotics]] x 10-14 days (before po)
#Refusal or inability to weight bear on affected joint
**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
#Fever
**Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]]


*1/4 criteria met --> 3% have septic joint
==Disposition==
*2/4 --> 40%
*Admit
*3/4 --> 93%
*4/4 --> 99%


==Treatment==
==External Links==
# drainage
*[http://www.mdcalc.com/kocher-criteria-septic-arthritis/ MDCalc - Kocher Criteria for Septic Arthritis]
# Oxacillin, Nafcillin or Clinda in pen all
# cover H. inf as needed w/ 3rd gen ceph.
# IV abx for 10-14 days before po


==See Also==
==See Also==
[[Hip Pain]]
*[[Hip Pain (Peds)]]
 
*[[Septic Arthritis (Peds)]]
[[Septic Arthritis (Peds)]]
*[[Limp (peds)]]


[[Septic Arthritis (General)]]
==References==
<references/>


[[Category:Peds]]
[[Category:Pediatrics]]
[[Category:Ortho]]
[[Category:Orthopedics]]
[[Category:ID]]

Latest revision as of 20:25, 26 February 2025

Background

Hip anatomy.
Extracapsular ligaments (anterior right hip).
Extracapsular ligaments (posterior right hip).

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

Other Causes of Limping

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:

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

Disposition

  • Admit

External Links

See Also

References

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