Septic arthritis of hip Flashcards
Hx
6 yr old male, unable to walk for 3 days due to painful l hip. stopped playing, unwell yesterday, fever and vomiting, no PMHx of note
look/inspect
looks unwell, antalgic gait, redness, swelling, L hip in FABER position [Flexed Abducted Laterally rotated]
feel
tenderness and warmth over lateral aspect of L hip
active movement
painful active ROM
passive movement
painful passive ROM
resisted movement
no pain
other exam findings
pyrexial T38^C
normal BMI
DDx
septic arthritis
transient synovitis [no infective symptoms, no fever]
Perthes disease [no infective symptoms]
why is septic arthritis likely?
acute onset pain, fever, feels unwell, pain limited AROM and PROM L hip
why is transient synovitis unlikely?
with irritable hip, but otherwise well
why is Perthes disease unlikely?
no fever, no redness, no swelling
investigations
bloods xray U/S MRI Joint aspiration
bloods
WCC, ESR, CRP
XRAY
AP and lateral
joint space widening or effusion
U/S
joint effusion/ guide aspirations
MRI
joint effusions
osteomyelitis
Joint aspiration for
microscopy culture and sensitivity
crystal analysis
non-op tx
urgent referral to ortho
IV antibiotics and analgesia
op tx
hip aspiration and IV antibiotics
irrigation and debridement of hip
hip aspiration and IV antibiotics
high clinical suspicion of septic arthritis
if symptoms do not resolve with NSAIDSs
Systemic infection
Kocher score over 2
irrigation and debridement of hip
documented infection
Kocher score 4/4
severe systemic infection with suspected septic hip
