Septic arthritis in children.

When septic arthritis involves the hip, the prognosis is much worse than with any other joint. Approximately 50 per cent of the results were unsatisfactory with hip involvement compared to 12 per cent unsatisfactory results with involvement of the other joints. The erythrocyte sedimentation rate is a much more helpful diagnostic test than the leukocyte count or differential cell count. The most important prognostic factors are the duration of symptoms prior to treatment, a penicillinase-producing organism (penicillin-resistant) as the etiologic agent, and evidence of associated metaphyseal osteomyelitis. Early decompression and cleansing of the joint by aspiration or arthrotomy are essential for a good result. Long-term parenteral antibiotic therapy improves the prognosis when osteomyelitis is an assoicated feature. Arthrotomy with continuous irrigation appears to be more effective in decreasing long-term residual effects than arthrotomy alone. Almost all secondary surgical procedures are directed toward correcting the sequelae of septic arthritis of the hip.