Paediatric septic arthritis of the hip is a surgical emergency requiring urgent washout (irrigation and debridement) of the infected hip joint. Delay risks permanent cartilage destruction and growth plate damage.
An incision is made over the front of the hip (anterior approach, typically Smith-Petersen). The joint capsule is opened and pus is drained. The joint is thoroughly washed with saline. Tissue and fluid samples are sent for urgent microbiology. A drain may be left in place. In some centres, arthroscopic washout is used. The operation takes 30–60 minutes.
Septic arthritis of the hip in a child is an emergency. The hip joint is deep and pus under pressure destroys articular cartilage within hours. The femoral head blood supply can be compromised, leading to avascular necrosis. Kocher's criteria (fever, non-weight-bearing, raised ESR, raised WCC) guide the clinical diagnosis.
Needle aspiration under ultrasound may be diagnostic and temporarily therapeutic. However, established septic arthritis with pus requires formal surgical washout — antibiotics alone are insufficient.
Emergency procedure. Blood tests (WCC, CRP, ESR, blood cultures). Ultrasound showing hip effusion. Joint aspiration if time allows (but must not delay surgery). The main differential diagnosis is transient synovitis — distinguishing the two is critical.
Drainage of pus to prevent cartilage destruction and AVN. When treated within 24 hours of onset, outcomes are generally excellent. Delay beyond 48–72 hours is associated with significantly worse outcomes.
May require repeat washout.
IV antibiotics for at least three to four weeks.
Temporary — usually recovers well in children.
Damage to the femoral head blood supply from pus under pressure.
May cause growth disturbance and leg length discrepancy.
Spread of infection to bone.
If treatment is delayed, the cartilage may be irreversibly damaged.
From capsular distension.
General anaesthesia. Emergency case — fasting status may need pragmatic management.
IV antibiotics for three to four weeks (may transition to oral if clinically and biochemically improving). Hip rest initially, then gradual return to weight-bearing. Most children recover fully. Follow-up X-rays to monitor for AVN and growth disturbance.
Daily clinical assessment while inpatient. Blood tests (CRP) to guide antibiotic duration. X-ray at six weeks. Long-term follow-up at six months, one year, and beyond to monitor for AVN and growth disturbance.
Both cause a painful, limping child with a hip effusion. Kocher's criteria (fever >38.5°C, non-weight-bearing, ESR >40, WCC >12,000) help differentiate — if three or four criteria are met, the probability of septic arthritis is high. If in doubt, aspiration is performed.
When treated promptly (within 24 hours), most children make a full recovery. Delayed treatment increases the risk of cartilage damage, AVN, and growth disturbance. Long-term follow-up is important to monitor hip development.