Septic Arthritis of the Knee in Children

Swarup, Ishaan; Meza, Blake C.; Weltsch, Daniel; Jina, Asmita A.; Lawrence, J. Todd R.; Baldwin, Keith

doi:10.2106/jbjs.rvw.19.00069

Cited by 20 publications

(47 citation statements)

References 100 publications

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“… 16 , 39 , 44 , 53 , 54 MRI, especially fat-suppressed, fluid-sensitive sequences, has been found to be helpful in differentiating AOI from transient synovitis of the hip 16 and Ewing’s sarcoma. 13 , 55 The presence of a soft tissue mass and the nature of the transition are critical to the diagnosis of Ewing’s sarcoma. 15 However, MRI findings should be interpreted with caution as they are not pathognomonic.…”

Section: Diagnostic Challengesmentioning

confidence: 99%

“…Paediatric AOI have a strong predilection in favour of large joints such as the hip, knee and shoulder, and/or their adjacent metaphyses. 3 , 4 , 7 , 13 , 14 The differential diagnosis of AOI is broad and multifaceted. The clinical picture of septic arthritis of the hip and osteomyelitis of the proximal femur overlap in various aspects.…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 9 Significant controversies exist as to the diagnostic role of acute phase reactants, synovial fluid analysis and culture, antimicrobial regimes and techniques of surgical drainage. 7 , 9 , 13 , 18 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

El-Sobky

Mahmoud

2021

EFORT Open Reviews

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Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis. A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management. Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician’s clinical judgment. Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve. The growing body of evidence on ‘high-risk’ children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets. Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis. Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155

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Section: Diagnostic Challengesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

El-Sobky

Mahmoud

2021

EFORT Open Reviews

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“…An accurate diagnosis is imperative to initiate treatment and probably to prevent further destruction of the cartilage. Generally, several predictive models and criteria have been established to distinguish between an SA and the more benign conditions, such as transient non-bacterial synovitis [ 1 , 2 , 3 , 4 , 5 , 6 ], viral arthritis, or other non-infectious affections, which would all influence the therapeutic approach.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Utility of Synovial Fluid Cell Counts and CRP in Pediatric Knee Arthritis: A 10-Year Monocentric, Retrospective Study

et al. 2022

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Background: Orthopedic surgeons often use the intra-articular white blood counts (WBCs) and the percentage of polymorphonuclear cells (PMN) in the diagnosis of an acute swollen and painful knee joint in children. Today, there is no established threshold for the synovial WBC, and their differentiation, as indicative of native joint knee bacterial arthritis. We determine the sensitivity and specificity of synovial WBCs and PMN percentages in the prediction of a community-acquired, acute bacterial native joint septic arthritis (SA) in the pediatric population. Methods: A retrospective study on healthy children 0–16 years of age who underwent knee joint aspiration for a community-acquired, acute irritable knee effusion in our tertiary-care children’s hospital between May 2009 and April 2019 was conducted. We divided the study population into two groups according to the detection of bacterial arthritis in the synovial fluid (bacterial arthritis versus its absence) and compared the intra-articular leukocyte and C-reactive protein (CRP) levels. Results: Overall, we found a statistically significant difference regarding the total CRP (p = 0.017), leukocyte or PMN counts (p ≤ 0.001 in favor of a bacterial arthritis). In contrast, the percentage of the neutrophils was not determinant for the later confirmation of bacterial pathogens, and we were unable to establish diagnostically determining minimal thresholds of the intra-articular CRP and leukocyte levels. Conclusions: This pilot study suggests that either the leukocyte or PMN counts may be associated with a bacterial origin of knee arthritis in children. We plan a larger prospective interventional study in the future to confirm these findings including the investigation of other joint aspirate biomarkers.

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“…1,2,10 Depending on the country, the yearly incidence of pediatric septic arthritis is between 1 and 35 cases per 100,000 children 2,7,[11][12][13][14][15][16][17] while rates within the United States range from 4 to 10 cases per 100,000 children. 3,7,9,17,18 The health burden of septic arthritis has not significantly changed over time, with yearly rates and the average length of hospitalization due to pediatric septic arthritis remaining at similar levels over a 20-year period. 16,17 Although its impact on patients' health has remained constant, septic arthritis' economic impact has continued to increase.…”

mentioning

confidence: 99%

Seasonal Variation of Pediatric Septic Arthritis in the United States: A PHIS Database Study

Patankar

Coene²,

Cook³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: The presence of seasonal patterns in pediatric septic arthritis cases is a common orthopaedic teaching. Seasonal variation has been seen in centers outside of the United States and with other inflammatory and infectious joint-related conditions within the country, but it is unknown if a seasonal pattern exists among different regions of the United States. The purpose of this study was to examine the seasonal variation of septic arthritis within specific regions across the United States. Methods: The Pediatric Health Information System database was queried for all patients 19 years or younger who were treated for septic arthritis. Data from 34 pediatric hospitals in the Pediatric Health Information System initiative were included. Centers were organized by geographical region, and season of presentation was determined using equinoxes/solstices. χ2 tests were performed to detect seasonal differences in septic arthritis for the entire cohort and separated by geographical region. Proportion differences along with 95% CIs were provided. Results: Between 2016 and 2019, there were 5764 cases of septic arthritis. Median age at diagnosis was 6.2 years (range: 0 to 19.0 y). Each season contributed 24% to 25% of the total septic arthritis cases, and there were no significant differences detected between the 4 seasons (P=0.66). There was no seasonal variation seen in the Midwest, South, or West (P=0.71, 0.98, 0.36, respectively). However, there was seasonal variation in the Northeast (P=0.05), with fall and summer having a higher percentage of cases (28%) than the winter (21%). Conclusions: This study showed no clear seasonal variation in septic arthritis in children across the United States using a national database of pediatric hospital centers. However, there is regional seasonal variation in the Northeast, which may relate to climate differences. With no clear seasonal variation across the United States, continued diligence is needed in diagnosing septic arthritis throughout the year. Level of Evidence: Prognostic II.

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Septic Arthritis of the Knee in Children

Cited by 20 publications

References 100 publications

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

Diagnostic Utility of Synovial Fluid Cell Counts and CRP in Pediatric Knee Arthritis: A 10-Year Monocentric, Retrospective Study

Seasonal Variation of Pediatric Septic Arthritis in the United States: A PHIS Database Study

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