Septic arthritis of the hip (peds)

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 hip pain

• 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

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

External Links

• MDCalc - Kocher Criteria for Septic Arthritis

See Also

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