Septic arthritis of the hip (peds): Difference between revisions

Latest revision as of 20:25, 26 February 2025

Background

Hip anatomy.

Extracapsular ligaments (anterior right hip).

Extracapsular ligaments (posterior right hip).

Age - 6 mo to 8 yrs
Hematogenous spread or local infection
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

Pediatric limp

Hip Related

Other Causes of Limping

Developmental dysplasia
Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
Osteomyelitis
Myositis
Other:

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

OR drainage
IV antibiotics x 10-14 days (before po)
- Oxacillin, Nafcillin or Clindamycin in penicillin allergic
- Cover Haemophilus influenzae as needed with 3rd generation cephalosporin

Disposition

Admit

External Links

MDCalc - Kocher Criteria for Septic Arthritis

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*hematogenous spread or local inf.
+{{Hip anatomy background images}}
-* wt. bearing joints most common
+*Age - 6 mo to 8 yrs
-* knee (40-50%)
+*Hematogenous spread or local infection
-* hip (20- 25%)
+*[[Staph]], [[S. Pneumo]], [[group A strep]]
-* staph, S. Pneumo, group A strep
+*Neonates: also [[Group B strep]] and [[gram negatives]]
-* in neonates also Groub B strep % gram neg.
-==Diagnosis==
+==Clinical Features==
-Age - 6 mo to 8 yrs
+*[[Hip pain (peds)|Pain]], pseudoparalysis
+*May present with referred knee or thigh pain
+*Usually hold joint in flexion, external rotation and slight abduction
-Pres - Pain, Pseudoparalysis
+==Differential Diagnosis==
+{{Pediatric hip DDX}}
-Labs - ESR > 20 after 1-2 d, WBC >
+==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:
+**[[musculoskeletal ultrasound|Ultrasound]] to evaluate for effusion
+**CT to evaluate for [[abscess]]
-Xrays - possible effusion
+{{Kocher criteria}}
+==Management==
+*OR drainage
+*IV [[antibiotics]] x 10-14 days (before po)
+**[[Oxacillin]], [[Nafcillin]] or [[Clindamycin]] in penicillin allergic
+**Cover [[Haemophilus influenzae]] as needed with 3rd generation [[cephalosporin]]
-- may present w/ referred knee or thigh pain
+==Disposition==
+*Admit
-- usually hold jt in flexion, ext rotat & slt abduction.
+==External Links==
+*[http://www.mdcalc.com/kocher-criteria-septic-arthritis/ MDCalc - Kocher Criteria for Septic Arthritis]
-- get Bld Cxs (40-50% grow out)
+==See Also==
+*[[Hip Pain (Peds)]]
+*[[Septic Arthritis (Peds)]]
-- Xrays useful to exclude other cause of joint pain (AP & Frog leg)
+*[[Limp (peds)]]
-- CT may be useful to look for abscess, UTZ for effusion.
-'''Kocher Criteria'''
+==References==
-. ESR > 40
+<references/>
-. WBC > 12
-. Refusal or inability to weight bear on affected joint
-. 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==
-[[Hip Pain]]
-[[Category:Peds]]
+[[Category:Pediatrics]]
-[[Category:Ortho]]
+[[Category:Orthopedics]]
+[[Category:ID]]