Paediatric Septic Arthritis of the Hip: Epidemiology, Diagnosis, and Treatment
Main Article Content
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.
Article Details
How to Cite
NUSEM, Iulian; SEHU, Marjoree.
Paediatric Septic Arthritis of the Hip: Epidemiology, Diagnosis, and Treatment.
Medical Research Archives, [S.l.], v. 11, n. 10, oct. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4031>. Date accessed: 31 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i10.4031.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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7. Kang SN, Sanghera T, Mangwani J et al: The management of septic arthritis in children: systematic review of the English language literature. J Bone Joint Surg 2009, 91-B(9): 1127-1133. DOI: 10.1302/0301-620X.91B9.22530.
8. Shah SS: Abnormal gait in a child with fever: diagnosing septic arthritis of the hip. Pediatr Emerg Care 2005, 21(5): 336-341. DOI: 10.1097/01.pec.0000159063.24820.73.
9. Okubo Y, Nochioka K, Marcia T: Nationwide survey of pediatric septic arthritis in the United States. J Orthop 2017, 14(3): 342-346. DOI: 10.1016/j.jor.2017.06.004.
10. Kariminasab MH, Shayesteh Azar M, Sajjadi Saravi M: Surgical intervention for treatment of septic arthritis in infancy and childhood: a retrospective study. Arch Iran Med 2009, 12(4): 409-411. PMID: 19566360
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23. Giufrè M, Lindh E, Cardines R et al: Invasive Haemophilus influenzae type b (Hib) disease in children in Italy, after 20 years of routine use of conjugate Hib vaccines. Vaccine 2020, 38(42): 6533-6538.
DOI: 10.1016/j.vaccine.2020.08.022.
24. Bardin T: Gonococcal arthritis. Best Pract Res Clin Rheumatol 2003, 17(2): 201–208. DOI: 10.1016/s1521-6942(02)00125-0.
25. Robertson AJF, Firth GB, Truda C et al: Epidemiology of acute osteoarticular sepsis in a setting with a high prevalence of pediatric HIV infection. J Pediatr Orthop 2012, 32(2): 215-219.
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30. Morrey BF, Bianco AJ, Rhodes KH: Suppurative arthritis of the hip in children. J Bone Joint Surg Am 1976 ,58(3): 388-392.
31. Chen CE, Ko JY, Li CC et al: Acute septic arthritis of the hip in children. Arch Orthop Trauma Surg 2001, 121(9): 521-526. ‘
DOI: 10.1007/s004020100280.
32. Kallio MJT, Unkila-Kallio L, Aalto K et al: Serum C-reactive protein, erythrocyte sedimentation rate and white blood cell count in septic arthritis of children. Pediatr Infect Dis J 1997, 16(4): 411-413. DOI: 10.1097/00006454-199704000-00015.
33. Singhal R, Perry DC, Khan FN et al: The use if CRP within clinical prediction algorithm for the differentiation of septic arthritis and transient synovitis in children. J Bone Joint Surg Br 2011, 93(11): 1556-1561. DOI: 10.1302/0301-620X.93B11.26857.
34. Carter K, Doern C, D, Jo C; Copleyet al: The clinical usefulness of polymerase chain reaction as a supplemental diagnostic tool in the evaluation and the treatment of children with septic arthritis. Journal of Pediatr Orthop 2016, 36(2): 167-172.
DOI: 10.1097/BPO.0000000000000411.
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DOI: 10.1007/BF00357107.
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38. Tuson CE, Hoffman EB, Mann MD: Isotope bone scanning for acute osteo myelitis and septic arthritis in children. J Bone Joint Surg Br 1994, 76(2): 306-310. PMID: 8113299.
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DOI: 10.1097/BPO.0000000000000602.
40. Mignemi ME, Menge TJ, Cole HA et al: Epidemiology, diagnosis, and treatment of periarticular pyomyositis of the hip in children. J pediatr Orthop 2014, 34(3): 316-325. DOI: 10.1097/BPO.0000000000000106.
41. Krul M, van der Wouden JC, Schellevis FG et al: Acute non-traumatic hip pathology in children: incidence and presentation in family practice. Fam Pract 2010, 27(2): 166-170. DOI: 10.1093/fampra/cmp092.
42. Kocher MS, Zurakowski D, Kasser JR: Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am 1999, 81(12): 1662-1670. DOI: 10.2106/00004623-199912000-00002.
43. Jung ST, Rowe SM, Moon ES et al: Significance of laboratory and radiologic findings for differentiating between septic arthritis and transient synovitis of the hip. L Pediatr Orthop 2003, 23(3): 368-372. PMID: 12724602.
44. Kocher MS, Mandiga R, Zurakowski D et al: Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am 2004, 86(8): 1629-1635. DOI: 10.2106/00004623-200408000-00005.
45. Luhmann SJ, Jones A, Schootman M: Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithm. J Bone Joint Surg Am 2004, 86(5): 956-962. DOI: 10.2106/00004623-200405000-00011.
46. Caird MS, Flynn JM, Leung YL et al: Factor distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am 2006, 88(6): 1251-1257. DOI: 10.2106/JBJS.E.00216.
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2. Al Saadi MM, Al Zamil FA, Buckhary NA et al: Acute septic arthritis in children. Pediatr Int 2009, 51(3): 377-380. DOI: 10.1111/j.1442-200X.2008.02791.
3. Lavy CB: Septic arthritis in Western and sub-Saharan African children-a review. Int Orthop 2007, 31(2): 137-144. DOI: 10.1007/s00264-006-0169-9.
4. Howard JB, Highgenboten CI, Nelson JD: Residual effects of septic arthritis in infancy and childhood. JAMA 1976, 236(8): 932-935. DOI: 10.1001/jama.1976.03270090026021.
5. Riise ØR, Kirkhus E, Handelend KS et al: Childhood osteomyelitis-incidence and differentiation from other acute on set musculoskeletal features in a population-based study. BMC Pediatr 2008, 8(1): 45. DOI: 10.1186/1471-2431-8-45.
6. Bowerman SG, Green NE, Mencio GA: Decline in bone and joint infections attributable to Haemophilus influenzae type B. Clin Orthop Relat Res 1997, 341: 128-133. DOI:10.1302/0301-620X.80B3.8296.
7. Kang SN, Sanghera T, Mangwani J et al: The management of septic arthritis in children: systematic review of the English language literature. J Bone Joint Surg 2009, 91-B(9): 1127-1133. DOI: 10.1302/0301-620X.91B9.22530.
8. Shah SS: Abnormal gait in a child with fever: diagnosing septic arthritis of the hip. Pediatr Emerg Care 2005, 21(5): 336-341. DOI: 10.1097/01.pec.0000159063.24820.73.
9. Okubo Y, Nochioka K, Marcia T: Nationwide survey of pediatric septic arthritis in the United States. J Orthop 2017, 14(3): 342-346. DOI: 10.1016/j.jor.2017.06.004.
10. Kariminasab MH, Shayesteh Azar M, Sajjadi Saravi M: Surgical intervention for treatment of septic arthritis in infancy and childhood: a retrospective study. Arch Iran Med 2009, 12(4): 409-411. PMID: 19566360
11. Frick SI: Evaluation of a child who has hip pain. Orthp Clin North Am 2006, 37(2): 133-140. DOI: 10.1016/j.ocl.2005.12.003
12. Takoma HC, Landham PR, Maconochie I: Towards evidence-based medicine for Paediatricians. Distinguishing between transient synovitis and septic arthritis in the limping child: how useful are clinical prediction tools? Arch Dis Child 2009, 94(2): 167-168.
DOI: 10.1136/adc.2008.152264.
13. Swarup I, La Valva S, Shah R et al: Septic arthritis of the hip in children-a critical analysis review. J Bone Joint Surg Rev 2020, 8(2): e0103. DOI: 10.2106/JBJS.RVW.19.00103.
14. Nunn TR, Cheung WY, Rollinson PD: A prospective study of pyogenic sepsis of the hip in children. J Bone Joint Surg 2007, 89-B(1): 100-106.
DOI: 10.1302/0301-620X.89B1.17940.
15. Lavy CBD, Peek AC, Manjolo G: The incidence of septic arthritis in Malawian children. Int Orthop 2005, 29(3): 195-196. DOI: 10.1007/s00264-005-0643-9.
16. Arnold SR, Elian D, Buckingham SC et al: Changing patterns of acute hemtogenous osteomyelitis and septic arthritis: emergence of community associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop 2006, 26(6): 703-708. DOI: 10.1097/01.bpo.0000242431.91489.b4.
17. Arkader A, Brusalis C, Warner WC Jr et al: Update on pediatric musculoskeletal infections: when it is, when it isn’t, and when to do. Am J Acad Orthop Surg 2016, 24(9): e112-121. DOI: 10.5435/JAAOS-D-15-00714.
18. Peltola H, Pääkkönen M, Kallio P et al: OM-SA Study Group. Clindamycin vs. first-generation cephlosporins for acute osteoarticular infections of childhood - a prospective quasi-randomized controlled trial. Clin Microbiol Infect 2012, 18(6): S82-89. DOI: 10.1111/j.1469-0691.2011.03643.x.
19. Burnett MW, Bass JW, Cook BA: Etiology of osteomyelitis complicating sickle cell disease. Pediatrics 1998, 101(2): 296-297. DOI: 10.1542/peds.101.2.296.
20. Foong B, Pak Leung Wong K, Joseph Jeyanthi C et al: Osteomyelitis in Immunocompromised children and neonates, a case series. BMC Pediatrics 2021, 21(1):568. DOI: 10.1186/s12887-021-03031-1.
21. Espinosa CM, Davis MM, Gilsdorf DP: Anaerobic osteomyelitis in children. Pediatr Infect Dis 2011, 30(5): 422-423. DOI: 10.1097/INF.0b013e318217ca0e.
22. Gamaletsou MN, Kontoyiannis DP, Sipsas NV et al: Candida osteomyelitis: analysis of 207 pediatric and adult cases. Clin Infect Dis 2012, 55(10): 1338-1351.
DOI: 10.1093/cid/cis660.
23. Giufrè M, Lindh E, Cardines R et al: Invasive Haemophilus influenzae type b (Hib) disease in children in Italy, after 20 years of routine use of conjugate Hib vaccines. Vaccine 2020, 38(42): 6533-6538.
DOI: 10.1016/j.vaccine.2020.08.022.
24. Bardin T: Gonococcal arthritis. Best Pract Res Clin Rheumatol 2003, 17(2): 201–208. DOI: 10.1016/s1521-6942(02)00125-0.
25. Robertson AJF, Firth GB, Truda C et al: Epidemiology of acute osteoarticular sepsis in a setting with a high prevalence of pediatric HIV infection. J Pediatr Orthop 2012, 32(2): 215-219.
DOI: 10.1097/BPO.0b013e3182468cd7.
26. Dart AH, Michelson KA, Aronson PL et al: Hip synovial fluid cell counts in children from Lyme disease endemic area. Pediatrics 2018, 141(5): e20173810.
DOI: 10.1542/peds.2017-3810.
27. Spyridakis E, Gerber JS, Schriver E et al: Features and Outcomes of Children with Culture-Negative Septic Arthritis. J Pediatric Infect Dis Soc 2019, 8(3): 228-234. DOI: 10.1093/jpids/piy034.
28. Smith IDM, Milto KM, Doherty CJ et al: A potential key role for alpha-haemolysin of staphylococcus aureus in mediating chondrocyte death in septic arthritis. Bone Joint Res 2018, 7(7): 457-467. DOI: 10.1302/2046-3758.77.BJR-2017-0165.R1.
29. Sultan J, Hughes PJ: Septic arthritis or transient synovitis of the hip in children: the value of clinical prediction algorithms. J bone Joint Surg Br 2010, 92(9): 289-293.
DOI: 10.1302/0301-620X.92B9.24286.
30. Morrey BF, Bianco AJ, Rhodes KH: Suppurative arthritis of the hip in children. J Bone Joint Surg Am 1976 ,58(3): 388-392.
31. Chen CE, Ko JY, Li CC et al: Acute septic arthritis of the hip in children. Arch Orthop Trauma Surg 2001, 121(9): 521-526. ‘
DOI: 10.1007/s004020100280.
32. Kallio MJT, Unkila-Kallio L, Aalto K et al: Serum C-reactive protein, erythrocyte sedimentation rate and white blood cell count in septic arthritis of children. Pediatr Infect Dis J 1997, 16(4): 411-413. DOI: 10.1097/00006454-199704000-00015.
33. Singhal R, Perry DC, Khan FN et al: The use if CRP within clinical prediction algorithm for the differentiation of septic arthritis and transient synovitis in children. J Bone Joint Surg Br 2011, 93(11): 1556-1561. DOI: 10.1302/0301-620X.93B11.26857.
34. Carter K, Doern C, D, Jo C; Copleyet al: The clinical usefulness of polymerase chain reaction as a supplemental diagnostic tool in the evaluation and the treatment of children with septic arthritis. Journal of Pediatr Orthop 2016, 36(2): 167-172.
DOI: 10.1097/BPO.0000000000000411.
35. Zieger MM, Dorr U, Schulz RD: Ultrasonography of hip joint effusions. Skeletal Radiol 1987,16(8): 607-611.
DOI: 10.1007/BF00357107.
36. Gordon EJ, Huang M, Dobbs M et al: Causes of false-negative ultrasound scans in the diagnosis of septic arthritis of the hip in children. J Pediatr Orthop 2002, 22(3): 312-316.
37. Zumzam MM: The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children. J Pediatr Orthop B 2006, 15(6): 418-422. DOI: 10.1097/01.bpb.0000228388.32184.7f
38. Tuson CE, Hoffman EB, Mann MD: Isotope bone scanning for acute osteo myelitis and septic arthritis in children. J Bone Joint Surg Br 1994, 76(2): 306-310. PMID: 8113299.
39. Nguyen A, Han JH, Bisset G et al: Kocher criteria revised in the era of MRI: how often does the Kocher criteria identify underlying osteomyelitis? J pediatr Orthop 2017, 37(2): e114-119.
DOI: 10.1097/BPO.0000000000000602.
40. Mignemi ME, Menge TJ, Cole HA et al: Epidemiology, diagnosis, and treatment of periarticular pyomyositis of the hip in children. J pediatr Orthop 2014, 34(3): 316-325. DOI: 10.1097/BPO.0000000000000106.
41. Krul M, van der Wouden JC, Schellevis FG et al: Acute non-traumatic hip pathology in children: incidence and presentation in family practice. Fam Pract 2010, 27(2): 166-170. DOI: 10.1093/fampra/cmp092.
42. Kocher MS, Zurakowski D, Kasser JR: Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am 1999, 81(12): 1662-1670. DOI: 10.2106/00004623-199912000-00002.
43. Jung ST, Rowe SM, Moon ES et al: Significance of laboratory and radiologic findings for differentiating between septic arthritis and transient synovitis of the hip. L Pediatr Orthop 2003, 23(3): 368-372. PMID: 12724602.
44. Kocher MS, Mandiga R, Zurakowski D et al: Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am 2004, 86(8): 1629-1635. DOI: 10.2106/00004623-200408000-00005.
45. Luhmann SJ, Jones A, Schootman M: Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithm. J Bone Joint Surg Am 2004, 86(5): 956-962. DOI: 10.2106/00004623-200405000-00011.
46. Caird MS, Flynn JM, Leung YL et al: Factor distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am 2006, 88(6): 1251-1257. DOI: 10.2106/JBJS.E.00216.
47. Shmerling R:H, Delbanco TL, Cole HA et al: Synovial fluid tests. What should be ordered? JAMA 1990, 264(8): 1009-1014.
48. Bennett OM, Namnyak : Acute septic arthritis of the hip joint in infancy and children. Clin Ortho Relat Res 1992, 281: 123-132. PMID: 1499198.
49. Broadhurst LE, Erickson RL, Kelley PW: Decreases in invasive Haemophilus influenzae diseases in US Army children, 1984 through 1991. JAMA 1993, 269:227-231. PMID: 8417240.
50. Pääkkönen M: Septic arthritis in children: diagnosis and treatment. Pediatric Health Med Ther. 2017, 8: 65–68. DOI: 10.2147/PHMT.S115429.
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