Review Question - QID 1347

The clinical scenario is consistent with a pediatric septic hip. The AP pelvis in figure A shows soft-tissue swelling with mild subluxation of the right hip due to a septic effusion, and the ultrasound in figure B also shows a hip effusion. The hip aspiration is consistent with an infectious process. An aspirate with WBC >50,000 is highly suggestive of a septic hip. Jackson et al reviewed pediatric septic arthritis and describe four poor prognostic signs: age <6 months, joint effusion with underlying osteomyelitis, hip involvement, and delay in treatment >4 days. In a review of pediatric septic hips, Sucato et al state that hip aspiration is the most sensitive test and that I&D is required to prevent late sequlae.