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

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