Septic arthritis of the hip (peds)

Background

• hematogenous spread or local inf.
• wt. bearing joints most common
• knee (40-50%)
• hip (20- 25%)
• staph, S. Pneumo, group A strep
• in neonates also Groub B strep % gram neg.

Diagnosis

Age - 6 mo to 8 yrs

Pres - Pain, Pseudoparalysis

Labs - ESR > 20 after 1-2 d, WBC >

Xrays - possible effusion

- may present w/ referred knee or thigh pain

- 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 1. ESR > 40

2. WBC > 12

3. Refusal or inability to weight bear on affected joint

4. Fever

• 1/4 criteria met --> 3% have septic joint
• 2/4 --> 40%
• 3/4 --> 93%
• 4/4 --> 99%

Treatment

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

See Also

Hip Pain

Septic Arthritis (Peds)

Authors:

Bobak Zonnoor, Claire, Michael Holtz, Neil Young, Nathan Wilkes, Daniel Ostermayer, robot, Ross Donaldson