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
- 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
See Also
Peds: Hip Pain
Septic Joint
- usu acute, same mech as OM, usu similar org w/ s. aureus most common (think gc if older).
- Rx= aspirate sufficient for all xcept hip, must go to OR/IR w/ hip b/c incr pressure can cause avn of hip! o/w tap okay, usu OR if reaccumulates. send for (in order) 1) cx 2) count 3) gs.
- CBC >15 in 50%, ESR >60mm/hr in >90% of cases, CRP >20mg/L in 94%, Bcx 50%, fluid usu >50,000 WBC
(in gc arthritis: +blood cx: ~0%, +fluid cx/gs: 25-50%, urethral/rectal/throat swab may incr cx yield)
- xr for septic hip usu w/ joint space wide of >1-2 mm vs other side
- Rx= neonate ox & gent, 2mo-5yr cefotax & ox, 5y-12y ox (vanco?), >12 ox & ctx