PATHOLOGY PARADING AS SEPTIC ARTHRITIS OF THE PEADIATRIC HIP – ESSENTIAL USE OF ULTRASOUND

Abstract

Aim: To audit the impact of emergency hip ultrasound in the management of suspected hip septic arthritis.

Methods and Results: Case series – Review of 13 consecutive patients who presented with acute hip pain, where clinical examination and inflammatory markers, highly suspicious of Septic arthritis.

• Emergency ultrasound was only available in 9 patients.

• Only 5 (38%) of these 13 patients had septic arthritis.

Septic arthritis group.

• – Emergency ultrasound unavailable in 2 patents. They proceeded straight to arthrotomy yielding pus.

• – 3 had a preoperative ultrasound which confirmed the hip joint had an effusion.

“Non Septic Arthritis of Hip” (8 patients).

• – In 2 patients emergency ultrasound unavailable. They underwent emergency arthrotomy with negative findings of pus.

• – 1 actually had septic arthritis of knee.

• – 6 patients did have emergency ultrasound which showed no effusion. Emergency arthrotomy was cancelled.

• – They proceeded to MRI of Hip. MRI revealed pathology close to but not involving the hip:

  1. Pelvic osteomyelitis,

  2. Psoas abscess,

  3. Gluteal abscess secondary to small bowel fistula

  4. Cellulitis of medial thigh

  5. Femoral Epiphysis osteomyelitis

  6. and inflammation of tendon secondary to line insertion.

  7. Inflammation of rectus femoris tendon (secondary to central line insertion). Conclusion: Use of ultrasound avoided unnecessary arthrotomy in 6 patients (48%).

If ultrasound was available in all cases, then 8 (63%) patients would have avoided an unnecessary arthrotomy.

Out of hours urgent hip ultrasound may be difficult to request. However our recent experience leads us to propose that if available ultrasound should be performed in all suspected case of hip septic arthritis prior to surgical drainage.

Pathology in the vicinity of the hip can often masquerade convincingly as a septic hip joint.