This 1997 narrative review by Sucato, Schwend, and Gillespie covers the full management spectrum of pediatric septic hip arthritis — from synovial pathophysiology and organism-specific antibiotic selection to surgical technique, sequelae classification, and reconstruction strategies. It asks: what does current evidence say about optimizing diagnosis and treatment to prevent devastating hip destruction in children?
When a child presents with a painful, held-externally-rotated hip and ESR >20 mm/hr with fever >37.5°C, treat as septic arthritis until proven otherwise — go to the OR for arthrotomy without waiting for culture results if aspiration yields pus.
Remember the four poor prognostic markers (age <6 months, delay >4 days, concurrent osteomyelitis, S. Aureus) and use the Hunka classification to guide sequelae management, reserving reconstruction for limb-length equalization and realignment rather than attempting to salvage a destroyed joint.
This 1997 narrative review by Sucato, Schwend, and Gillespie covers the full management spectrum of pediatric septic hip arthritis — from synovial pathophysiology and organism-specific antibiotic selection to surgical technique, sequelae classification, and reconstruction strategies. It asks: what does current evidence say about optimizing diagnosis and treatment to prevent devastating hip destruction in children?
When a child presents with a painful, held-externally-rotated hip and ESR >20 mm/hr with fever >37.5°C, treat as septic arthritis until proven otherwise — go to the OR for arthrotomy without waiting for culture results if aspiration yields pus.
Remember the four poor prognostic markers (age <6 months, delay >4 days, concurrent osteomyelitis, S. Aureus) and use the Hunka classification to guide sequelae management, reserving reconstruction for limb-length equalization and realignment rather than attempting to salvage a destroyed joint.