-
Diff Dx:
-
reactive transient synovitis (toxic synovitis)
- in the report by MS Kocher et al., the authors sought to distinguish transient synovitis vs sepsis on the basis of lab data and patient history;
- independent clinical predictors between septic arthritis and transient synovitis included history of fever, non-wt-bearing,
ESR of at least forty mm/hr, and serum WBC of more than 12,000;
- the predicted probability for septic arthritis were 93% if three of these variables were present and were over 99% if all 4 predictors were present;
- the authors recommend careful observation without aspiration if none of the four independent predictors are present;
- reference:
- Differentiating Between Septic Arthritis and Transient Synovitis of the Hip in Children: An Evidence-Based Clinical Prediction Algorithm. MS Kocher MD.
JBJS. Vol 81-A. Dec 1999. p 1662.
-
Legg-Calve-Perthes disease
-
slipped capital femoral epiphysis
- psoas abscess:
- note that these patients will hold the hip in flexion and in internal rotation (which is also seen in septic arthritis of the hip);
- look for atypical features, such as femoral nerve neurapraxia or bladder irritability along with hip pain;
- references:
- Psoas abscess in children.
SD Schwaitzberg.
J. Pediatric Surgery. Vol 20. 1985. 339-342.
- Differentiation of Psoas Muscle Abscess From Septic Arthritis of the Hip in Children.
John Song, MD. CORR 2001;2001:258-265
- obturator internus pyomyositis:
- patients may demonstrate rectal pain and swelling during an examination;
- in the report by Shari L. Orlicek, M.D. et al, the authors describe 4 cases of obturator internus muscle (OIM) abscess in children,
including their clinical presentations and treatment;
- common presenting features were fever, limp, and hip pain;
- CT or MRI was diagnostic in all 4 patients, and staph aureus was the causative agent in each;
- all the patients recovered, one after surgical drainage and the other three after antimicrobial therapy alone or with needle aspiration;
- presentation of OIM pyomyositis is similar to that of psoas muscle pyomyositis and other infectious processes of the pelvis and hip;
- most patients can be managed without open surgical drainage, but needle aspirations may be helpful both therapeutically and diagnostically;
- references:
- Case Report.
Obturator Internus Pyomyositis.
M. Papadopoulos MD.
Orthopedics. Apr 2000. p 383.
- Obturator Internus Muscle Abscess in Children. Shari L. Orlicek, M.D. Journal of Pediatric Orthopaedics. 2001;21:744-748
- acetabular osteomyelitis
-
pyogenic sacroiliitis
-
vertebral/disc space infections
- proximal femoral
osteomyelitis (see above)
-
sickle cell anemia;
-
juveline rheumatoid arthritis
-
neuroblastoma
- uncommon but should be considered in the differential diagnosis;
- abdominal ultrasonography may serve as a screening examination;
Suppurative arthritis of the hip in children.
Long-term follow-up of infantile hip sepsis.
J Pediatr Orthop 1988;8:322-325. Wopperer JM, White JJ, Gillespie R, et al:
Sequelae and reconstruction after septic arthritis of the hip in infants.
J Bone Joint Surg 1990;72A:1150-1165. Choi IH, Pizzutillo PD, Bowen JR, et al:
Evaluation of treatment modalities for septic arthritis with histologic grading and analysis of
levels of uronic acid, neutral protease, and interleukin-1.
KD Nord et al. JBJS Vol 77-A. p 258-265. 1995.
Acute hematogenous osteomyelitis and septic arthritis in childhood: A 10 year review and follow up. S Petersen et al.
Acta Orthop Scand. Vol 51: 1980. p 451-457.
Acute septic arthritis of the hip joint in infancy and childhood.
Pyogenic arthritis associated with adjacent osteomyelitis:
Identification of the sequelae prone child. MA Jackson et al.
Pediatric Infectious Disease Journal.
Vol 11. 1992. p 9-13;
The Role of Pelvic Magnetic Resonance in Evaluating Nonhip Sources of Infection in Children With Acute Nontraumatic Hip Pain.
