Septic arthritis of the hip (peds)

Background

  • 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 hip pain

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
13%
240%
393%
499%

Management

Disposition

  • Admit

See Also

References

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