Septic arthritis of the paediatric hip - A review of current diagnostic approaches and therapeutic concepts.

A misdiagnosed septic arthritis (SA) of the paediatric hip is a nightmare for many physicians. The authors tried to trace the most recent information about this problem. A Medline search, using PubMed interface, was focused on the period from 01.01.2002 to 31.08. 2012. A total of 53 papers were included in the study. They led to the following statement, among others, about the differential diagnosis between SA and transient synovitis: "CRP > 20 mg/L, non-weight-bearing, temperature >38.5 degrees C and peripheral white blood cell count > 12 x 10(9) cells /L offers a predictive probability for septic arthritis of 87%". As soon as the clinical data point to septic arthritis, a diagnostic needle aspiration becomes mandatory : for cell count, Gram stain and culture. Immediately afterwards, antibiotics should be started, knowing that they need to be adapted to the antibiogram as soon as it is available. If the clinical picture and the CRP improve within 24 hours, antibiotics are continued, classically for 3 to 3.5 weeks. If not, some kind of surgical intervention becomes necessary: arthrotomy, or daily repeated ultrasound-guided aspiration and irrigation, or arthroscopic irrigatiop and drainage. A diagnostic and therapeutic algorithm is presented. Finnish current literature proposes to reduce the aggressiveness of the treatment of SA, at least in previously healthy children with a short medical history (less than 5 days) : antibiotic therapy of less than two weeks and avoidance of a surgical intervention, apart from a diagnostic needle aspiration, might be justifiable in these cases.