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Relevant factors in the diagnosis of concomitant osteomyelitis in pediatric hip septic arthritis. A series of 41 cases treated by hip arthroscopy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Septic arthritis of the hip can appear isolated or concomitant with pelvic osteomyelitis. Delay in the diagnosis of a concomitant osteomyelitis increases the number of required surgeries and of possible complications.

Purpose

This study aims to establish relevant factors in the diagnosis of concomitant osteomyelitis in cases with septic arthritis of the hip among paediatric patients.

Methods

The data were collected between 2005 and 2020. 41 pediatric patients with suspicion of septic arthritis of the hip joint, treated arthroscopically, were included. The following diagnostic test parameters were collected: ultrasound, MRI, X-Rays, blood samples, temperature, and incapacity to bear weight. The data were analysed with the sensitive analysis method using descriptive statistic.

Results

41 patients were analyzed, with an average age of 6.04 y (7 months to 14 years), of which ten patients (24.39%) presented concomitant osteomyelitis. 6 out of ten patients needed secondary surgery. Regarding age, concomitant osteomyelitis was most common in the age group 4–14 years old. Average number of days of clinical symptoms before admission was 6.2 days. 36/41 cases showed CRP values higher than 2 mg/dl. 9/10 cases with concomitant osteomyelitis showed a CRP > 2 mg/dl, with an average value of 8.9 mg/dl. 22/41 patients underwent an MRI, of which nine cases presented a concomitant osteomyelitis.

The probability of a child to have septic arthritis of the hip with adjacent osteomyelitis was analysed through a score based on four factors: impossibility to bear weight and/or hip pain in children in the non-walking age category, CRP > 2 mg/dl, age older than > 4 y, symptoms longer than 4 days.

Conclusions

Children at the age of walking, with incapacity to bear weight, presenting symptoms longer than 4 days and a CRP > 2 mg/dl, should receive an MRI before surgery to exclude adjacent osteomyelitis.

Level of evidence

IV.

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Authors and Affiliations

  1. Orthopaedic Department, Olgahospital Stuttgart, Kriegsbergstrasse 62, 70174, Stuttgart, Germany

    Cezara Danilov, F. F. Fernandez, T. Wirth & O. Eberhardt

Authors
  1. Cezara Danilov
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  2. F. F. Fernandez
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  3. T. Wirth
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  4. O. Eberhardt
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Contributions

DC—main author, patient data extract from archive, statistical data, writing, searching the literature. FFF—great experience in septic joint infections, such as the main senior supervisor, intellectual inputs, review of text and data. WT—experience in septic joint infections, intellectual input, review of text. EO—main senior supervisor with experience in septic joint infections, closely monitoring the patient data, the factors examined, significant intellectual inputs, correcting the manuscript and improving the structure.

Corresponding author

Correspondence to Cezara Danilov.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. We provided for this study the vote from the ethical regional committee. This study does not contain any studies with animals performed by any of the authors.

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We did not have informed consent from the patients, due to retrospective study.

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Danilov, C., Fernandez, F.F., Wirth, T. et al. Relevant factors in the diagnosis of concomitant osteomyelitis in pediatric hip septic arthritis. A series of 41 cases treated by hip arthroscopy. Arch Orthop Trauma Surg 143, 1825–1832 (2023). https://doi.org/10.1007/s00402-022-04371-y

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  • DOI: https://doi.org/10.1007/s00402-022-04371-y

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