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Septic arthritis of the hip (peds)
From WikEM
Contents
Background
- Hematogenous spread or local infection
- Staph, S. Pneumo, group A strep
- Neonates: also Group B strep and gram negatives
Clinical Features
- Age - 6 mo to 8 yrs
- Pain, Pseudoparalysis
- May present with referred knee or thigh pain
- Usually hold joint in flexion, external rotation and slight abduction
Differential Diagnosis
Pediatric hip pain
- Septic arthritis of the hip (peds)
- Slipped capital femoral epiphysis
- Legg-Calve-Perthes disease
- Transient (toxic) synovitis
- Acute rheumatic fever
- Juvenile idiopathic arthritis
- Developmental dysplasia of hip
- Femur fracture
Evaluation
Workup
- Labs - ESR > 20 after 1-2 d, WBC >
- Bld Cxs (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
- WBC > 12
- Refusal or inability to weight bear on affected joint
- Fever
| 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
- Admission
