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


==Clinical Features==
==Clinical Features==
*Age - 6 mo to 8 yrs
*[[Hip pain (peds)|Pain]], pseudoparalysis
*Pain, Pseudoparalysis
*May present with referred knee or thigh pain
* May present with referred knee or thigh pain
*Usually hold joint in flexion, external rotation and slight abduction
* Usually hold joint in flexion, external rotation and slight abduction


==Differential Diagnosis==
==Differential Diagnosis==
{{Pediatric hip DDX}}
{{Pediatric hip DDX}}


==Diagnosis==
==Evaluation==
===Workup===
===Workup===
*Labs - ESR > 20 after 1-2 d, WBC >
*Labs - ESR >20, WBC >12
* Bld Cxs (40-50% grow out)
*Blood cultures (40-50% grow out)
* Xrays  
*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
**[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion
**CT to evaluate for [[abscess]]


===Kocher Criteria===
{{Kocher criteria}}
*ESR > 40
*WBC > 12
*Refusal or inability to weight bear on affected joint
*Fever


 
==Management==
*1/4 criteria met --> 3% have septic joint
*OR drainage
*2/4 --> 40%
*IV [[antibiotics]] x 10-14 days (before po)
*3/4 --> 93%
*4/4 --> 99%
 
==Treatment==
* OR drainage
* IV [[antibiotics]] x 10-14 days (before po)
**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
** Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]]
**Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]]


==Disposition==
==Disposition==
*Admission
*Admit


==External Links==
==External Links==
Line 48: Line 40:


==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]]
[[Category:ID]]

Latest revision as of 20:25, 26 February 2025

Background

Hip anatomy.
Extracapsular ligaments (anterior right hip).
Extracapsular ligaments (posterior right hip).

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 limp

Hip Related

Other Causes of Limping

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:

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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