Septic arthritis of the hip (peds): Difference between revisions
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==Background==
==Background==
*hematogenous spread or local inf.
*Age - 6 mo to 8 yrs
* [[Staph]], [[S. Pneumo]], [[group A strep]]
*Hematogenous spread or local infection
* in neonates also [[Group B strep]] and [[gram negatives]]
*[[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==
==Differential Diagnosis==
{{Pediatric hip DDX}}
{{Pediatric hip DDX}}


==Workup==
==Evaluation==
*Labs - ESR > 20 after 1-2 d, WBC >
===Workup===
* Bld Cxs (40-50% grow out)
*Labs - ESR >20, WBC >12
* Xrays  
*Blood cultures (40-50% grow out)
*Xrays  
**useful to exclude other cause of joint pain (AP & Frog leg)
**useful to exclude other cause of joint pain (AP & Frog leg)
**possible effusion
**possible effusion
* CT
*Consider:
**may be useful to look for abscess, UTZ for effusion
**Ultrasound to evaluate for effusion
**CT to evaluate for abscess


==Diagnosis==
{{Kocher criteria}}
*Age - 6 mo to 8 yrs
*Pres - Pain, Pseudoparalysis
* may present w/ referred knee or thigh pain
* usually hold jt in flexion, ext rotat & slt abduction.


===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==
* OR drainage
* Oxacillin, Nafcillin or Clinda in pen all
* cover H. inf as needed w/ 3rd gen ceph.
* IV abx for 10-14 days before po


==External Links==
==External Links==
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==See Also==
==See Also==
*[[Hip Pain]]
*[[Hip Pain (Peds)]]
*[[Hip Pain (Peds)]]
*[[Septic Arthritis (Peds)]]
*[[Septic Arthritis (Peds)]]
*[[Septic Arthritis (General)]]
*[[Limp (peds)]]
 
==References==
<references/>


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

Revision as of 23:48, 21 May 2018

Background

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

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

Disposition

  • Admit

External Links

See Also

References

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