eMedicine Specialties > Orthopedic Surgery > Pediatrics

Septic Arthritis, Pediatrics: Multimedia

Author: Edwards P Schwentker, MD, Professor, Departments of Orthopedics and Rehabilitation and Pediatrics, Pennsylvania State College of Medicine
Contributor Information and Disclosures

Updated: Jan 21, 2009

Multimedia

Emergency room photograph of an infant with septi...
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Media file 1: Emergency room photograph of an infant with septic arthritis of the left hip. The child holds his hip rigidly in the classic position of flexion, abduction, and external rotation, a position that maximizes capsular volume. The patient is relatively comfortable as long as the hip joint remains immobile in this position.
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Emergency room photograph of an infant with septi...

Emergency room photograph of an infant with septic arthritis of the left hip. The child holds his hip rigidly in the classic position of flexion, abduction, and external rotation, a position that maximizes capsular volume. The patient is relatively comfortable as long as the hip joint remains immobile in this position.

This is the first radiograph in a series of 6 (se...
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Media file 2: This is the first radiograph in a series of 6 (see Images below) that document the natural history and complications of an inadequately treated septic arthritis of the left hip. The child is aged 22 months and had been symptomatic for a week before this radiograph was obtained. No bone changes are seen, but the left hip is laterally subluxated.
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This is the first radiograph in a series of 6 (se...

This is the first radiograph in a series of 6 (see Images below) that document the natural history and complications of an inadequately treated septic arthritis of the left hip. The child is aged 22 months and had been symptomatic for a week before this radiograph was obtained. No bone changes are seen, but the left hip is laterally subluxated.

Second radiograph in the series of a septic left ...
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Media file 3: Second radiograph in the series of a septic left hip. Three days after presentation and 10 days after the onset of symptoms, there is still no change in the bone's appearance, but the hip joint is further subluxated.
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Second radiograph in the series of a septic left ...

Second radiograph in the series of a septic left hip. Three days after presentation and 10 days after the onset of symptoms, there is still no change in the bone's appearance, but the hip joint is further subluxated.

Third radiograph in the series of a septic left h...
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Media file 4: Third radiograph in the series of a septic left hip. Three weeks after presentation, the left hip is dislocated, and new periosteal bone formation is noted. This last finding is characteristic of an associated osteomyelitis of the left femur.
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Third radiograph in the series of a septic left h...

Third radiograph in the series of a septic left hip. Three weeks after presentation, the left hip is dislocated, and new periosteal bone formation is noted. This last finding is characteristic of an associated osteomyelitis of the left femur.

Fourth radiograph in the series of a septic left ...
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Media file 5: Fourth radiograph in the series of a septic left hip. Seven weeks after onset, increased opacity is noted in the central portion of the proximal femoral metaphysis and in the proximal femoral epiphysis. The findings are consistent with avascular necrosis of these structures.
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Fourth radiograph in the series of a septic left ...

Fourth radiograph in the series of a septic left hip. Seven weeks after onset, increased opacity is noted in the central portion of the proximal femoral metaphysis and in the proximal femoral epiphysis. The findings are consistent with avascular necrosis of these structures.

Fifth radiograph in the series of a septic left h...
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Media file 6: Fifth radiograph in the series of a septic left hip. Five months after onset, the femoral head has been completely resorbed, and the femoral shaft has regenerated.
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Fifth radiograph in the series of a septic left h...

Fifth radiograph in the series of a septic left hip. Five months after onset, the femoral head has been completely resorbed, and the femoral shaft has regenerated.

Sixth radiograph in the series of a septic left h...
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Media file 7: Sixth radiograph in the series of a septic left hip. At age 11, or 9 years after onset of the infection, the hip joint and the proximal femoral growth plate are destroyed. A profound limb-length discrepancy is noted, in addition to severely impaired hip function.
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Sixth radiograph in the series of a septic left h...

Sixth radiograph in the series of a septic left hip. At age 11, or 9 years after onset of the infection, the hip joint and the proximal femoral growth plate are destroyed. A profound limb-length discrepancy is noted, in addition to severely impaired hip function.

More on Septic Arthritis, Pediatrics

Overview: Septic Arthritis, Pediatrics
Workup: Septic Arthritis, Pediatrics
Treatment: Septic Arthritis, Pediatrics
Follow-up: Septic Arthritis, Pediatrics
Multimedia: Septic Arthritis, Pediatrics
References
Further Reading
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References

  1. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am. Dec 2005;19(4):853-61. [Medline].

  2. Frank G, Mahoney HM, Eppes SC. Musculoskeletal infections in children. Pediatr Clin North Am. Aug 2005;52(4):1083-106, ix. [Medline].

  3. Peltola H, Kallio MJ, Unkila-Kallio L. Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination. Implications for treatment. J Bone Joint Surg Br. May 1998;80(3):471-3. [Medline].

  4. Moylett EH, Rossmann SN, Epps HR, Demmler GJ. Importance of Kingella kingae as a pediatric pathogen in the United States. Pediatr Infect Dis J. Mar 2000;19(3):263-5. [Medline].

  5. Kehl-Fie TE, Miller SE, St Geme JW 3rd. Kingella kingae expresses type IV pili that mediate adherence to respiratory epithelial and synovial cells. J Bacteriol. Aug 29 2008;[Medline].

  6. Yagupsky P, Bar-Ziv Y, Howard CB, Dagan R. Epidemiology, etiology, and clinical features of septic arthritis in children younger than 24 months. Arch Pediatr Adolesc Med. May 1995;149(5):537-40. [Medline].

  7. Mataika R, Carapetis JR, Kado J, Steer AC. Acute rheumatic fever: an important differential diagnosis of septic arthritis. J Trop Pediatr. Jun 2008;54(3):205-7. [Medline].

  8. Willis AA, Widmann RF, Flynn JM, Green DW, Onel KB. Lyme arthritis presenting as acute septic arthritis in children. J Pediatr Orthop. Jan-Feb 2003;23(1):114-8. [Medline].

  9. Song J, Letts M, Monson R. Differentiation of psoas muscle abscess from septic arthritis of the hip in children. Clin Orthop Relat Res. Oct 2001;(391):258-65. [Medline].

  10. Korakaki E, Aligizakis A, Manoura A, Hatzidaki E, Saitakis E, Anatoliotaki M, et al. Methicillin-resistant Staphylococcus aureus osteomyelitis and septic arthritis in neonates: diagnosis and management. Jpn J Infect Dis. May 2007;60(2-3):129-31. [Medline].

  11. Arnold SR, Elias D, Buckingham SC, Thomas ED, Novais E, Arkader A, et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop. Nov-Dec 2006;26(6):703-8. [Medline].

  12. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. Dec 1999;81(12):1662-70. [Medline].

  13. Caird MS, Flynn JM, Leung YL, Millman JE, D'Italia JG, Dormans JP. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. Jun 2006;88(6):1251-7. [Medline].

  14. Arnold SR, Elias D, Buckingham SC, Thomas ED, Novais E, Arkader A, et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop. Nov-Dec 2006;26(6):703-8. [Medline].

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Keywords

septic arthritis, pediatric septic arthritis, septic arthritis and infectious diseases, septic arthritis--radiology, septic arthritis--surgery, joint infections, septic joint, suppurative arthritis, bacterial arthritis, acute septic arthritis, juvenile rheumatoid arthritis, pyogenic arthritis, gonococcal arthritis, Haemophilus influenzae, Haemophilus influenzae type b, H influenzae type b, Staphylococcus aureus, S aureus

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Contributor Information and Disclosures

Author

Edwards P Schwentker, MD, Professor, Departments of Orthopedics and Rehabilitation and Pediatrics, Pennsylvania State College of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Charles T Mehlman, DO, MPH, Director, Musculoskeletal Outcomes Research, Associate Professor, Division of Pediatric Orthopedic Surgery, Cincinnati Children's Hospital Medical Center
Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George H Thompson, MD, Director, Pediatric Orthopedics, Rainbow Babies and Children's Hospital
George H Thompson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

 
 
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