Paediatric Septic Arthritis of the Hip: Epidemiology, Diagnosis, and Treatment

Abstract

Background: Septic arthritis of the hip is an orthopaedic emergency which requires prompt diagnosis and treatment. If treated late or inadequately, it can have devastating consequences for the development of the hip joint. Infection is most commonly caused by Staphylococcus aureus which spreads via the blood stream or from an adjacent area of osteomyelitis. Diagnosing and managing this condition continue to be challenging and poor outcomes may occur. Neonates may present with sepsis and failure to thrive. There may be no fever. The hip is held in flexed, abducted and externally rotated position. The limb is held still and any passive movement causes pain. Older children typically present with a limp or refusal to walk. Children typically have elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Needle aspiration is the most specific diagnostic test. Prompt surgical drainage and postoperative antibiotic therapy until signs of infection resolve are necessary to prevent late sequelae. Objectives: The present review aims to discuss the published evidence related to the diagnosis of septic arthritis of the hip based on history, physical examination, laboratory tests, imaging studies and arthrocentesis, and management including antibiotic treatment and surgical joint debridement. Conclusion: With prompt diagnosis and appropriate treatment, outcomes are generally good, with only few long-term sequelae. Delay in diagnosis and treatment may result in growth disturbances and joint destruction.