Septic arthritis of the hip (peds)

Background

• Hematogenous spread or local infection
• Staph, S. Pneumo, group A strep
• Neonates: also Group B strep and gram negatives

Clinical Features

• Age - 6 mo to 8 yrs
• 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:
  • Appendicitis
  • Meningitis
  • Epidural abscess (spinal)

Evaluation

Workup

• Labs - ESR > 20 after 1-2 d, WBC >
• Bld Cxs (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

• Admission

External Links

• MDCalc - Kocher Criteria for Septic Arthritis

See Also

• Hip Pain (Peds)
• Septic Arthritis (Peds)
• Limp (peds)