Septic Hip Arthrotomy in Children

Indications

Septic Arthritis, radiograph of the left hip in septic arthritis caused by melioidosis
Radiograph of the left hip in septic arthritis caused by melioidosis. Image by N. P. Weerasinghe, H. M. M. Herath and T. M. U. Liyanage, Wikimedia Commons, CC BY 4.0.
  • Septic arthritis of the hip, an emergency
  • Positive aspirate or high clinical probability (Kocher criteria)
  • Kocher criteria are inability to weight bear, fever over 38.5 degrees, ESR over 40 mm/hr and white cell count over 12 x 109/L
  • CRP over 20 mg/L adds predictive value
  • Ultrasound guided aspiration confirms an effusion and obtains fluid

Position

  • Supine, bump under the buttock

Operative Steps

  1. Anterior approach through a bikini incision, or anterolateral approach
  2. Protect the lateral femoral cutaneous nerve
  3. Capsulotomy, window or T shaped
  4. Send fluid and tissue for Gram stain, culture and PCR
  5. Irrigate the joint thoroughly
  6. Look for femoral neck osteomyelitis
  7. Close over a drain
  8. Arthroscopic washout is an alternative in experienced hands
  9. Kingella kingae is common under 4 years and is best detected by PCR

Postoperative Care

  • IV antibiotics, early switch to oral based on CRP and clinical response
  • Repeat washout if not improving
  • Follow up for growth disturbance
  • Total antibiotic course is usually 2 to 3 weeks in uncomplicated cases
  • MRI if not improving to look for adjacent osteomyelitis or abscess

Complications

  • Avascular necrosis
  • Physeal arrest and leg length difference
  • Dislocation and joint destruction with delay
  • Chondrolysis and stiffness
  • Recurrent infection

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.