Septic arthritis of the hip joint can be a devastating problem, and is primarily a pediatric disease. Septic arthritis of the hip joint develops secondary to hematogenous introduction of bacteria through the synovium, or from the proximal femoral metaphysis. The most common organisms found are group B streptococci, Staph. aureus, Strept. pneumoniae, and H. influenza type B.13 Destruction of articular cartilage may ensue if prompt drainage is not performed.
Clinically, the child may present with pain, limp, or refusal to move the affected joint. The pain is usually found on the anterior aspect of the hip joint and may radiate to the knee. The child often holds the hip flexed, externally rotated, and abducted to maximize the joint space. Fever may or may not be present.
Laboratory workup should include white blood cell count with differential, ESR, C-reactive protein, and blood cultures. Plain radiographs may be inconclusive. Ultrasound may help with diagnosis in unclear cases.
The goals of treatment of septic arthritis of the hip are decompression of the joint capsule, joint debridement, reduction of bacterial load, and dismantling of loculations. Hip ar-throscopy is an excellent alternative to arthrotomy. The surgeon may obtain culture and sensitivities, debride the joint, and place a drain, all without creating a large incision. Chung et al performed arthroscopic lavage in nine patients, age 2-7 years old, who had positive cultures of the hip joint. Each patient received a total of 3-6 weeks of antibiotic treatment postoperatively. The patients experienced no recurrences requiring additional surgical intervention. The authors emphasized large-bore arthroscopy intrumentation, high-volume lavage, and postoperative suction drainage.14
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