Septic Arthritis, Hip

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
Septic arthritis is most commonly due to staphylococcus that seeds the intraarticular part of the femoral metaphysis during septicemia. Complications that can occur if treatment is not prompt can include joint destruction, epiphysis ossification center destruction, secondary osteomyelitis, and joint capsule contraction.

Pathology:
Not applicable.

Imaging Findings:
Plain film can show osteopenia of femoral epiphysis and metaphysis due to disuse or hyperemia, increased medial joint space due to increased pressure from joint fluid (Waldenstein's sign), and frank osteomyelitis. Cartilage destruction and femoral head overgrowth may be seen late.

Ultrasound allows direct visualization of a hip effusion, if one is present.

DDX:

• Transient toxic synovitis - self limited hip inflammation of unknown etiology
• Chronic polyarthritis - juvenile rheumatoid arthritis, ankylosing spondylitis, lupus, psoriasis
• Traumatic synovitis - hemarthrosis
• Legg Perthes disease - early in its course
• Leukemia
• Osteoid osteoma of proximal femoral metaphysis

References:
See References Chapter.

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