- Diff Dx:
- Evaluation: (before antibiotics are infused):
-
synovial fluid analysis
- culture & gram's stain;
-
leukocyte count
- glucose and viscosity (both decreased w/ infection);
- blood culture, CBC, CRP, &
sed rate
- radiographs (and possibly ultrasound):
- need to rule out concomitant metaphyseal osteomyelitis;
- misc:
bone scans
- Treatment:
- based on
antimicrobial suseptabilities as well as patient age:
-
less than 3 months
-
from 6 mo to 2 yrs
-
greater than 2 yrs;
-
drainage:
- drainage can be provided by repeated closed needle aspiration, arthroscopy, or arthrotomy;
-
septic hip demands open drainage;
- if joint cannot be adequately drained because of loculations or if the joint is not responding
clinically with gradually decreasing synovial-fluid leukocyte counts and negative cultures,
open surgical drainage will be necessary ;
