Septic arthritis in children

Abstract

A differential diagnosis of septic arthritis in children can be difficult, but early treatment of joint infections avoids potentially disabling complications

The child with joint pain in primary care

“…Classically, the child will be febrile and reluctant to weight-bear or move the joint, although signs and symptoms are often more subtle in younger children. On closer inspection, the joint is usually red, hot, swollen and markedly tender [85]. There are significant numbers of children in the community who are immunosuppressed, due to either medication or concurrent illnesses, and these children require a higher level of suspicion.…”

Septic Arthritis: A Need to Strengthen the Referral Chain in a Developing Economy

“…Whereas the pathogenesis is multifactorrial and diagnosis based on isolation of bacterial species from synovial fluid, there is a major role for clinical history, physical signs of inflammation, infection, laboratory features, and imaging studies [9]. The condition is managed in conjunction with an Orthopaedic surgeon [25]. The findings in this study agree with other studies that Staphylococcus aureus is the commonest causative organism [1,10,30,31], and the knee joint is the commonest affected joint [1,10,12].…”

“…The probability that the patient has septic arthritis is 99% when all 4 criteria are met, 93% when 3 criteria are present, 40% when 2 criteria are met and 3% when only one criteria is met. If none is met, the probability of septic arthritis is less than 0.2% [23][24][25]. To improve diagnostic accuracy, other researchers have added to Kocher's criteria a c-reactive protein > 200 mg/l or a history of a previous healthcare visit [26,27].…”

“…Recurrent needle aspirations combined with antibiotics have been used to treat septic arthritis [9]. However, permanent joint damage is established after 5 days of infection [9,25] and there is insufficient evidence to recommend repeated aspirations as routine practice [25]. Tidal irrigation is as effective as Arthroscopy and may be useful when multiple joint aspiration yields fluid with different characteristics, an indication of loculation of pus in different pockets within the joint.…”

“…Other indications are the need for urgent decompression because of neuropathy and compromised vascularization, pre-existing joint damage and when the affected joints are inaccessible by less invasive means. Open arthrotomy in all cases of hip and most cases of knee and shoulder sepsis remains a major therapeutic option among Orthopaedic surgeons [25].…”