What is septic arthritis?

Septic arthritis is inflammation of a joint caused by bacteria. Bacteria usually enter the joint through hematogenous spread – through the blood from other parts of the body (tooth, skin wounds, etc.). One theory about the origin of septic arthritis suggests that it occurs as a direct consequence of acute bone inflammation (osteomyelitis) in the part of the bone covered by the joint capsule. As a result of inflammation, bacteria, leukocytes, and effusion accumulate in the joint, creating pus. If pus is present in the joint for more than four days, it leads to permanent damage to the joint cartilage or even the growth plate of the bone, with catastrophic consequences for the joint. Children with septic arthritis appear sick, exhausted, and have an elevated body temperature. They complain of pain in the affected joint, which is swollen, warm, and reddish. Inflammatory parameters in the blood, such as white blood cell count, CRP, and ESR, are always elevated. Because of all these reasons, septic arthritis is an urgent condition in pediatric orthopedics that requires a quick diagnosis and appropriate treatment. Usually, it involves surgical treatment – removal of pus with joint lavage and prolonged antibiotic therapy.

What is septic arthritis of the hip?

Septic arthritis of the hip is the most common purulent joint inflammation in children. It is a highly dangerous and urgent condition that needs to be recognized as soon as possible because bacteria entering the hip create pus, which over time damages the cartilage of the hip joint’s femoral head or acetabulum. Joint damage can be so severe that shortly after the end of bone growth, children may need hip replacement – total hip prosthesis. Symptoms in children usually start with an elevated temperature over several days, limited mobility, and thigh pain. Since the hip is deeper in the body, the skin above the hip is normal. Parents describe the child’s general malaise and irritability. In the youngest children, the leg may be in a “pseudoparalyzed” position, and changing diapers causes pain and intense crying. Far more common difficulty related to children’s hips is transient synovitis, where symptoms initially resemble those of septic arthritis (limping and pain). However, in transient synovitis, children are in good general condition and without a fever, and sometimes they may have slightly elevated CRP values.

How to confirm septic arthritis of the hip?

Through a conversation in the clinic and based on a clinical examination, suspicion of septic arthritis of the hip may arise. If a child limps or cannot walk, has an elevated body temperature, and looks sick, it is necessary to perform an ultrasound examination of the hips as soon as possible and look for effusion in the joint. Basic laboratory tests should always be performed, checking white blood cell counts, CRP, and ESR, which are then elevated. Due to insight into bone conditions, an X-ray of the hips is recommended. Other diseases that can initially cause similar hip problems include juvenile idiopathic arthritis, osteomyelitis of the pelvis or femur, and psoas muscle abscess. However, through further diagnostic testing, these conditions can be confirmed and treated.

How to treat septic arthritis of the hip?

The old surgical rule is that every pus needs to be evacuated – removed from the body. The same applies to septic arthritis of the hip. Today’s surgical methods include arthroscopic (using special instruments and through small skin incisions) cleaning of pus and joint lavage, as well as classic opening of the joint capsule – arthrotomy and joint lavage. During the operation, a sample of pus is taken and sent for microbiological analysis to confirm the causative agent. Antibiotic therapy begins immediately after surgery, and initially, medications are given directly into the bloodstream, intravenously. During this time, the child needs to be in the hospital. Once inflammatory parameters decrease, antibiotic therapy switches to oral tablets, and the child can then be at home. The total duration of antibiotic treatment can be up to six weeks.

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