Septic Arthritis/Osteitis is a devastating condition which may affect children of all ages, however, the most common incidence is in a seven-year-old male patient. The child presents with rapidly increasing pain around the hip, refusal to walk as well as “pseudo-paralysis” (weakness of the leg muscles which is not of neuromuscular origin). The hip is often held in a flexed, adducted and internally rotated position and the patient may develop a temperature and, in severe cases may be systemically toxic. An extremely high index of suspicion for this condition should be maintained, as it is one of the absolute orthopaedic emergencies and necessitates surgical management as soon as possible. Once the hip has been surgically drained and parental antibiotics have been administered, the patient usually recovers symptomatically over the next week. Prolonged antibiotic treatment is required and it is worth noting that patients younger than two years old with septic arthritis of the hip inevitably also suffer from osteitis.
Patients who present late with Septic Arthritis have worse results, both in terms of mortality rates, as well as in terms of the incidence of chondrolysis and chronic osteitis. If chondrolysis is allowed to develop, early onset osteoarthritis is usually unavoidable, unless hip fusion or complete proximal femoral destruction occurs, in which case a total hip replacement will also ultimately be required.
