synonyms: Septic Hip, pediatric septic arthritis
Pediatric Septic Arthritis ICD-10
Pediatric Septic Arthritis ICD-9
- 711.40 Arthropathy associated with other bacterial disease; site unspecified
- 711.41 Arthropathy associated with other bacterial disease; shoulder
- 711.42 Arthropathy associated with other bacterial disease; upper arm
- 711.43 Arthropathy associated with other bacterial disease; forearm
- 711.44 Arthropathy associated with other bacterial disease; hand
- 711.45 Arthropathy associated with other bacterial disease; pelvic region and thigh
- 711.46 Arthropathy associated with other bacterial disease; lower leg
- 711.47 Arthropathy associated with other bacterial disease; ankle and foot
- 711.48 Arthropathy associated with other bacterial disease; other specified sites
Pediatric Septic Arthritis Etiology / Epidemiology / Natural History
- Most common in children <3y/o.
- M:F = 2:1
- Hip most common site (80%)
- Most common organism: S aureus. Others: group A beta-hemolytic streptococcus, S pneumoniae, Haemophilus influenzea type B, Kingella kingae( after URI), salmonella, Pseudomonas aeruginosa, Neisseria meningitidis, N gonorrhoeae, gram-negative bacilli.
Pediatric Septic Arthritis Anatomy
Pediatric Septic Arthritis Clinical Evaluation
- Pain in the affected joint, fever, edema, swelling, inability to bear weight, anorexia, irritability, pseudoparalysis
- Labs: ESR, CBC with diff
- Infection indicated by: (1)inability to bear weight, (2)fever, (3)ESR>40mm/h, (4)WBC >12,000/mm3 (Kocher MS, JBJS 2004;86A:1629).
Pediatric Septic Arthritis Xray / Diagnositc Tests
- CBC with differential, ESR (rises within 2 days, continues to rise for 3-5 days even with treatment), CRP (rises witin 6 hours, peaks at 48 hrs, normal witin 1 week), blood cultures, gram stain. Consider Acid-fast staining, fungal cultures, prolonged incubation times (especially for infections after arthroscopic surgery).
- Xray: demonstrate soft-tissue swelling / loss of tissue planes / widened joint space. Generally normal.
- Joint aspiration: generally ultrasound guided. Aspirate sent for Gram stain, CBC with differential, aerobic and aerobic cultures and sensitivities, acid-fast staining. WBC count >12,000/mm3 with 40-60% PMNs, ESR>55mm/h indicates infection.
- Consider MRI
Pediatric Septic Arthritis Classification / Treatment
- IV antibiotics and surgical irrigation and debridement. IV antibiotics should be continued for at least 1 week and followed with 2 weeks of PO antiobitcs.
- Hip Drainage: oblique incision over the femoral neck. Standard anterior approach to the hip with excision of a portion of the capsule. Cultures. Irrigate. Pass small hemostat bluntly from the anterior incision the the posterior capsule , just posterior to the gluteus medius to tent the skin proximally over the greater trochanter. Make stab incision and pull hemovac drain retrograde into the joint. Suture drain in place. Close anterior incision. (Smith MJ, Am J Orthop 2007;36:165).
Pediatric Septic Arthritis Associated Injuries / Differential Diagnosis
Pediatric Septic Arthritis Complications
- physeal destruction
- Epiphyseal osteonecrosis
- Leg-length discrepancy
- Hip dislocation
Pediatric Septic Arthritis Follow-up Care
- Follow responce to treatment with serial ESR and CRP. CRP returns to normal in 1 week, ESR in 3 weeks with adequate treatment. May switch to PO antibiotics once CRP normalizes.
- Consider physical therapy
- Blood testing and serum drug levels indicated depending on antibiotic chosen.
Pediatric Septic Arthritis Review References