The Hip: Preservation, Replacement and Revision

Treatment of Septic Joint Based on Age

  - Treatment Based on Age:

    - less than 3 months
            - up to 60-100% of neonates w/ septic arthritis have adjacent osteomyelitis.
            - septic arthritis is both more common and more often associated w/ metaphyseal osteomyelitis in neonates than in older children;
            - may occur from transphyseal blood vessels (see epiphyseal vessels), which disappear by age six months, and from synovial reflections over
                    metaphyseal bone, which decrease with age;
                    - in the older children, only the metaphysis of the shoulder, hip, radial head and ankle remains intracapsular;
    - from 6 mo to 2 yrs
            - there should first be a search for evidence of other infections because a large percentage (50%) of children w/ hematogenous osteomyelitis
                   and septic arthritis have evidence of an associated infection;
            - concomitant meningitis may occur in up to 20% of patients w/ septic arthritis due to H. influenzae;
                   - cerebrospinal examination should be considered and antibiotics that can cross the blood-brain barrier should be chosen;
     - greater than 2 yrs
          - references:
                - Acute septic arthritis in infancy and childhood. 10 years' experience.
                - Management of septic arthritis in children.
                - Septic arthritis in children.  
                - Septic arthritis in infants and children: a review of 117 cases.   
    - 5 to 15 years:
          - diff dx: acute rheumatic fever
    - adults:
          - staph aereus
          - streptococcus
                - adults with septic arthritis due to streptococcus should be worked up for multiple myeloma

Septic Arthritis and Acute Rheumatic Fever in Children: The Diagnostic Value of Serological Inflammatory Markers

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 19, 2015 1:27 pm