Tag Archive for: septic arthritis

Septic Arthritis Management: Current Guidelines

Volume 8 | Issue 1 | January-April 2022 | Page: 08-13 | Gaurav Gupta, Easwar T. Ramani, Gaurav Garg, Maulin Shah

Authors: Gaurav Gupta MS Ortho. [1, 2], Easwar T. Ramani MS Ortho. [3, 4 ], Gaurav Garg MS Ortho. [5], Maulin Shah MS Ortho. [6]

[1] Department of Paediatric Orthopaedics, Asian Hospital, Faridabad, UP, India.
[2] Department of Orthopaedics, Child Ortho Clinic, Faridabad & Delhi, India.
[3] Department of Paediatric Orthopaedics, Baby Memorial Hospital, Kozhikode, Kerala, India.
[4] Department of Paediatric Orthopaedics and Spine Surgery, Palakkad District Cooperative & Research Centre, Palakkad, Kerala, India.
[5] Department of Paediatric Orthopaedics, Excelcare Hospital, Jaipur, India.
[6] Department of Paediatric Orthopaedics, Orthokid Clinic, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Maulin Shah,
Consultant Paediatric Orthopaedic Surgeon, Orthokid Clinic, Ahmedabad, Gujarat, India.
E-mail: maulinmshah@gmail.com


Septic arthritis is an orthopaedic emergency that is more commonly seen in infants and young children. Release of proteolytic enzymes leads to permanent destruction of intra-articular cartilage and subchondral bone as early as 72 hours after onset. Hip and knee are the most commonly involved joints. Staphylococcus aureus is the most common causative organism across all paediatric age groups. Recently, there is a significant increase in incidence of Klebsiella and Pseudomonas, especially in neonates. Sensitivity patterns of causative organisms are also changing with increasing resistance to empirical antibiotics, requiring the use of higher antibiotics.
The detection of septic arthritis in neonates is challenging. The physician has to rely on indirect signs and maintain a high index of suspicion. C-reactive protein (CRP) along with difficulty in weight bearing have a better predictive value in diagnosis. Ultrasonography (USG) is a useful tool for quick screening of a joint and to detect effusion. Many recent studies have suggested percutaneous drainage/aspiration as an equally effective modality to manage septic joints, thus avoiding the morbidity of open arthrotomy and the risks of general anaesthesia. Lack of response to minimally invasive methods warrant an open approach. Antero-lateral arthrotomy is preferred over the posterior approach to avoid iatrogenic damage to the blood supply of the femoral head. Arthroscopic lavage of the septic joint is also becoming popular. The choice of empiric antibiotic treatment should be based on age, vaccination status and underlying co-morbidities. There is growing evidence in literature for short-course intravenous (IV) therapy. Delayed diagnosis, sickle cell disease, and infection caused by certain strains of methicillin-resistant staphylococcus aureus (MRSA) are predispose to orthopaedic sequelae.
Keywords:  Septic Arthritis, Arthrotomy, Osteomyelitis.


1. Momodu II, Savaliya V. Septic Arthritis.In:StatPearls[Internet.Treasure Island(FL):StatPearlsPublishing;2022 https://www.ncbi.nlm.nih.gov/books/NBK538176/
2. Anil Agarwal, Aditya N. Aggarwal. Bone and Joint Infections in Children: Septic Arthritis. Indian J Pediatr 2015 July 21. DOI 10.1007/s12098-015-1816-1.
3. T. Sreenivas, A. R. Nataraj, Anand Kumar, Jagdish Menon. Neonatal septic arthritis in a tertiary care hospital: a descriptive study. Eur J Orthop Surg Traumatol 2016 May 6. DOI 10.1007/s00590-016-1776-9.
4. Gireesh Sankaran, Balaji Zacharia1, Antony Roy1, Sulaikha Puthan Purayil. Current clinical and bacteriological profile of septic arthritis in young infants: a prospective study from a tertiary referral centre. European Journal of Orthopaedic Surgery & Traumatology 2018 February 9. https://doi.org/10.1007/s00590-018-2142-x.
5. Rai A, Chakladar D, Bhowmik S, Mondal T, Nandy A, Maji B, et al. Neonatal septic arthritis: Indian perspective. Eur J Rheumatol 2020; 7(Suppl 1): S72-S77.
6. Agarwal A, Aggarwal AN. Septic arthritis in children. In: Agarwal A, Aggarwal AN, editors. Pediatric osteoarticular infections. Delhi: Jaypee; 2014. p. 60–74.
7. Giovanni Autore, Luca Bernardi, Susanna Esposito. Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Anti Infective Therapy. Antibiotics 2020, 9, 486; doi:10.3390/antibiotics9080486.
8. Sultan J, Hughes PJ. Septic arthritis or transient synovitis of the hip in children: the value of clinical prediction algorithms. J Bone Joint Surg Br. 2010;92(9):1289–1293.
9. Ju KL, Zurakowski D, Kocher MS. Differentiating between methicillin-resistant and methicillin-sensitive Staphylococcus aureus osteomyelitis in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 2011;93(18):1693–1701
10. Yagupsky P, Dubnov-Raz G, Gené A, Ephros M, Israeli-Spanish Kin-gella kingae Research Group Differentiating Kingella kingae septic arthritis of the hip from transient synovitis in young children. J Pediatr. 2014;165(5):985–989.
11. Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 2004 Aug;86(8):1629-35. doi: 10.2106/00004623-200408000-00005. PMID: 15292409.
12. Pääkkönen M. Septic arthritis in children: diagnosis and treatment. Pediatric Health Med Ther. 2017;8:65-68. Published 2017 May 18. 10.2147/PHMT.S115429.
13. Singhal R, Perry DC, Khan FN, Cohen D, Stevenson HL, James LA, Sampath JS, Bruce CE. The use of CRP within a clinical prediction algorithm for the differentiation of septic arthritis and transient synovitis in children. J Bone Joint Surg Br. 2011 Nov;93(11):1556-61. doi: 10.1302/0301-620X.93B11.26857. PMID: 22058311.
14. Krogstad P. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, editors. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Saunders; 2009. pp. 725–748.
15. G. Fabry, E. Miere. Septic arthritis hip in children : poor results after late and inadequate treatment. JPO -A , 3: 461-466, 1983.
16. W A Herndon, S Knauer, J A Sullivan, R H Gross. Management of septic arthritis in children. J Pediatr Ortho, Sep-Oct 1986;6(5):576-8. doi: 10.1097/01241398-198609000-00009.
17. Uri Givon 1, Boaz Liberman, Amos Schindler, Alexander Blankstein, Abraham Ganel. Treatment of septic arthritis of the hip joint by repeated ultrasound-guided aspirations. J Pediatr Orthop May-Jun 2004;24(3):266-70. doi: 10.1097/00004694-200405000-00006.
18. Daniel M Weigl 1, Tali Becker, Eyal Mercado, Elhanan Bar-On. Percutaneous aspiration and irrigation technique for the treatment of pediatric septic hip: effectiveness and predictive parameters. J Pediatr Orthop B 2016 Nov;25(6):514-9. doi: 10.1097/BPB.0000000000000345.
19. Ahmad Essa 1, Michael Asa’af, Haim Shtarker. Preliminary results: continuous double luminal catheter drainage for the management of septic hip arthritis in children. J Pediatr Orthop B,2022 Jan 1;31(1):e11-e16. doi: 10.1097/BPB.0000000000000866.
20. Kristin S Livingston 1, Leslie A Kalish 2, Donald S Bae 3, Young-Jo Kim 3, Benjamin J Shore. Wash, Rinse, Repeat: Which Patients Undergo Serial Joint Irrigation in Pediatric Septic Hip Arthritis? J Pediatr Orthop. 2019 Aug;39(7):e494-e499. doi: 10.1097/BPO.0000000000001323.
21. Gaurav Gupta 1, Qaisur Rabbi, Vikas Bohra, Maulin M Shah. Protrusio acetabulae as a sequel to septic arthritis of the hip with obturator internus pyomyositis. J Pediatr Orthop B,2021 Nov 1;30(6):572-578. doi: 10.1097/BPB.0000000000000823.
22. Garg R, Ho J, Gourineni PV. Simplified arthroscopic lavage of pediatric septic hip: case series. J Pediatr Orthop B. 2020 May;29(3):304-308. doi: 10.1097/BPB.0000000000000717.
23. Thompson RM, Gourineni P. Arthroscopic Treatment of Septic Arthritis in Very Young Children. J Pediatr Orthop. 2017 Jan;37(1):e53-e57. doi: 10.1097/BPO.0000000000000659
24. Eric W Edmonds 1 2, Christina Lin 1, Christine L Farnsworth 2, James D Bomar 2, Vidyadhar V Upasani 1 2 . A Medial Portal for Hip Arthroscopy in Children With Septic Arthritis: A Safety Study. J Pediatr Orthop Nov/Dec 2018;38(10):527-531. doi: 10.1097/BPO.0000000000000861.
25. Scott Rosenfeld 1, Derek T Bernstein, Shiva Daram, John Dawson, Wei Zhang. Predicting the Presence of Adjacent Infections in Septic Arthritis in Children. J Pediatr Orthop 2016 Jan;36(1):70-4. doi: 10.1097/BPO.0000000000000389.
26. Corey O Montgomery 1, Eric Siegel, Robert D Blasier, Larry J Suva. Concurrent septic arthritis and osteomyelitis in children. J Pediatr Orthop , 2013 Jun;33(4):464-7. doi: 10.1097/BPO.0b013e318278484f.
27. Jedidiah E Schlung 1, Tracey P Bastrom 2, Joanna H Roocroft 2, Peter O Newton 2, Scott J Mubarak 1 2, Vidyadhar V Upasani. Femoral Neck Aspiration Aids in the Diagnosis of Osteomyelitis In Children With Septic Hip. J Pediatr Orthop ,Nov/Dec 2018;38(10):532-536. doi: 10.1097/BPO.0000000000000868.
28.Clinical Practice Guideline by PIDS and IDSA • JPIDS 2021
29. Ohl CA. Infectious arthritis of native joints. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa.: Churchill Livingstone; 2010:1443-1456.
30. Liu C, Bayer A, Cosgrove SE, et al; Infectious Diseases Society of America. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18–e55
31. No authors listed. British Society for Antimicrobial Chemotherapy.http://www.bsac.org.uk/pyxis/Bone%20and%20joint/Septic%20arthritis/Septic%20arthritis.htm(date last accessed 28 February 2009).
32. Vinod MB, Matussek J, Curtis N, Graham HK, Carapetis JR. Duration of antibiotics in children with osteomyelitis and septic arthritis. J Paediatr Child Health 2002;38:363-7
33. Peltola H, Paakkonen M, Kallio P, Kallio MJ; OM-SA Study Group. Clindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood – a prospective quasi-randomized controlled trial. Clin Microbiol Infect. 2012;18(6):582–589.
34. Peltola H, Paakkonen M, Kallio P, Kallio MJ; Osteomyelitis-Septic Arthritis (OM-SA) Study Group. Prospective, randomized trial of 10 days versus 30 days of antimicrobial treatment, including a short-term course of parenteral therapy, for childhood septic arthritis. Clin Infect Dis. 2009;48(9):1201–1210

How to Cite this Article:  Gupta G, Ramani ET, Garg G, Shah M | Septic Arthritis Management: Current Guidelines | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 08-13.

(Article Text HTML)      (Full Text PDF)

Pelvic Pyomyositis in Children: Current Concepts Review

Volume 8 | Issue 1 | January-April 2022 | Page: 02-07 | Archan Desai, Ashish Ranade, Mohan V. Belthur, Sandeep Patwardhan, Gauri A. Oka

Authors: Archan Desai [1], Ashish Ranade [1, 2], Mohan V. Belthur [3], Sandeep Patwardhan [4], Gauri A. Oka [1]

[1] Department of Orthopaedics, Bharati Hospital and Research Centre, Pune, Maharashtra, India.
[2] Department of Orthopaedics, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India.
[3] Department of Child Health & Orthopaedics, University of Arizona College of Medicine-Phoenix, USA.
[4] Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Ashish Ranade,
Consultant Paediatric Orthopaedic Surgeon, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India. Visiting Pediatric Orthopaedic Surgeon, Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India
E-mail: ranadea2@gmail.com


Pyomyositis in children is an uncommon bacterial infection of skeletal muscles which has more frequently been described in tropical areas, but it is becoming increasingly recognized in temperate climates too. Any muscle group in the body can be involved, but it commonly affects the large muscle groups which are located around the pelvic girdle and lower extremities. Clinical presentation is very similar to septic arthritis of the hip and needs to be diagnosed early. MRI is the investigation of choice. Depending on the severity this condition, it can be treated conservatively with antibiotics in its early stage and with percutaneous or formal incision and drainage in later stages. Generally, if it is diagnosed early, good outcomes can be expected.
Keywords: Pelvic Pyomyositis, Septic arthritis, Infection, Magnetic resonance imaging


1. Bickels J, Ben-Sira L, Kessler A, Wientroub S. Primary pyomyositis. J Bone Joint Surg Am. 2002; 84(12):2277-2286.
2. Anand SV, Evans KT. Pyomyositis. Br J Surg. 1964; 51:917-920.
3. Levin MJ, Gardner P, Waldvogel FA. An un-usual infection due to staphylococcus aureus. N Engl J Med. 1971; 284(4):196-198.
4. Ciampi MA, Sadigh M, Sherwood JA, Protopapas Z, Thornton GF, Andriole VT. Temperate pyomyositis at two community hos-pitals. Infect Dis Clin Pract. 1998; 7:265-273.
5. Chiedozi LC: Pyomyositis: review of 205 cases in 112 patients, Am J Surg 137:255, 1979
6. De Boeck H, Noppen L, Desprechins B: Pyomyositis of the adductor muscles mimicking an infection of the hip. Diagnosis by magnetic resonance imaging: a case report, J Bone Joint Surg Am 76:747, 1994.
7. Hernandez RJ, Strouse PJ, Craig CL, et al: Focal pyomyositis of the perisciatic muscles in children, AJR Am J Roentgenol 179:1267, 2002.
8. Kadambari D, Jagdish S: Primary pyogenic psoas abscess in children, Pediatr Surg Int 16:408, 2000.
9. Orlicek SL, Abramson JS, Woods CR, et al: Obturator internus muscle abscess in children, J Pediatr Orthop 21:744, 2001.
10. Garcia-Mata S, Hidalgo-Ovejero A, Esparza-Estaun J. Primaryobturator-muscle pyomyositis in immunocompetent children. JChild Orthop. 2012;6:205–15.
11. Taksande A, Vilhekar K, Gupta S. Primary pyomyositis in a child. Int J Infect Dis. 2009;13(4):e149–51.
12. Christin L, Sarosi GA. Pyomyositis in North America: case reports and review. Clin Infect Dis. 1992;15:668–77.
13. Crum NF (2004) Bacterial pyomyositis in the United States. Am JMed 117(6):420–428
14. Moriarty P, Leung C, Walsh M, Nourse C (2015) Increasingpyomyositis presentations among children in Queensland,Australia. Pediatr Infect Dis J 34(1):1–4
15. Brown JD, Wheeler B (1984) Pyomyositis. Report of 18 cases inHawaii. Arch Intern Med 144(9):1749–1751
16. Verma S, Singhi SC, Marwaha RK, et al. Tropical pyomyositis inchildren: 10 years experience of a tertiary care hospital in northernIndia. J Trop Pediatr. 2013;59(3):243–5.
17. Gambhir IS, Singh DS, Gupta SS, Gupta PR, Kumar M. Tropicalpyomyositis in India: a clinico-histopathological study. J Trop MedHyg. 1992;95(1):42–6.
18. Malhotra P, Singh S, Sud A, et al. Tropical pyomyositis-experienceof a tertiary care hospital in North West India. J Assoc PhysiciansIndia. 2000;48:1057–60.
19. Chauhan S, Kumar R, Singh KK, Chauhan SS. Tropical pyomyositis: adiagnostic dilemma. J Ind Acad Clin Med. 2004;5:52–4.
20. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis(myositis tropicans): current prospective. Postgrad Med J. 2004;80:267–70.
21. Smith MI, Vickers AB. Natural history of 338 treated and untreatedpatients with staphylococcal septicaemia (1936–1955). Lancet.1960;1(7138):1318–22.
22. Jayoussi R, Bialik V, Eyal A, Shehadeh N, Etzioni A. Pyomyositiscaused by vigorous exercise in a boy. Acta Paediatr. 1995;84(2):226–7.
23. Singh SB, Singh VP, Gupta S, Gupta RM, Sunder S. Tropical myo-sitis: a clinical, immunological and histopathological study. J AssocPhysicians India. 1989;37(9):561–3
24. Flier S, Dolgin SE, Saphir RL, et al: A case confirming the progressive stages of pyomyositis, J Pediatr Surg 38:1551, 2003.
25. .Moriarty, Leung C, Walsh M, Nourse C. Increasing pyomyositis presenting among children in Queensland, Australia. PediatrInfect Dis J. 2015;34(1):1–4.
26. Pannaraj PS, Hulten KG, Gonzalez BE, Mason Jr EO, Kaplan SL.Infective pyomyositis and myositis in children in the era of com-munity-acquired, methicillin-resistant Staphylococcus aureus infec-tion. Clin Infect Dis. 2006;43:953–60.
27. Mitchell PD, Hunt DM, Lyall H, Nolam M, et al. Panton-Valentineleukocidin-secreting Staphylococcus aureus causing sever muscu-loskeletal sepsis in children. A new threat. J Bone Joint Surg (Br).2007;89:1239–42.
28. Menge TJ, Cole HA, Mignemi ME, et al. Medial approach fordrainage of the obturator musculature in children.J Pediatr Orthop.2014;34:307–315.
29. Spiegel DA, Meyer JS, Dormans JP, et al. Pyomyositis in childrenand adolescents: report of 12 cases and review of the literature.JPediatr Orthop. 1999;19:143–150.
30. Renwick SE, Ritterbusch JF. Pyomyositis in children.J PediatrOrthop. 1993;13:769–772.
31. Mazur JM, Ross G, Cummings J, et al. Usefulness of magneticresonance imaging for the diagnosis of acute musculoskeletalinfections in children.J Pediatr Orthop. 1995;15:144–147.
32. Peckett WR, Butler-Manuel A, Apthorp LA. Pyomyositis of theiliacus muscle in a child.J Bone Joint Surg Br. 2001;83:103–105.
33. Thomas S, Tytherleigh-Strong G, Dodds R. Pyomyositis of theiliacus muscle in a child.J Bone Joint Surg Br. 2001;83:619–620.
34. Yuh WT, Schreiber AE, Montgomery WJ, et al. Magnetic resonanceimaging of pyomyositis.Skeletal Radiol. 1988;17:190–193.
35. Kocher MS, Zurakowski D, Kasser JR (1999) Differentiating be-tween septic arthritis and transient synovitis of the hip in children:an evidence- based clinical prediction algorithm. J Bone Joint SurgAm 81(12):1662–1670
36. Bertrand SL, Lincoln ED, Prohaska MG. Primary pyomyositis ofthe pelvis in children: a retrospective review of 8 cases.Orthopedics. 2011;34(12):832–40.
37. Unnikrishnan PN, Perry DC, George H, Bassi R, Bruce CE.Tropical primary pyomyositis in children of the UK: an emerging medical challenge. Int Orthop. 2010;34:109–13.
38. Kiran M, Mohamed S, Newton A, George H, Garg N, Bruce C. Pelvic pyomyositis in children: changing trends in occurrence and management. Int Orthop. 2018 May;42(5):1143-1147.
39. Birkbeck D, Watson JT (1995) Obturator internus pyomyositis. Acase report. Clin Orthop Relat Res 316:221–226
40. Tucker RE, Winter WG, Del Valle C, Uematsu A, Libke R(1978) Pyomyositis mimicking malignant tumor. Three casereports. J Bone Joint Surg Am 60:701–703
41. Karmazyn B, Loder RT, Kleiman MB, et al. The role of pelvicmagnetic resonance in evaluating nonhip sources of infection inchildren with acute nontraumatic hip pain.J Pediatr Orthop.2007;27:158–164.
42. Ovadia D, Ezra E, Ben-Sira L, et al. Primary pyomyositis inchildren: a retrospective analysis of 11 cases.J Pediatr Orthop B.2007;16:153–159.
43. Browne LP, Mason EO, Kaplan SL, et al. Optimal imaging strategyfor community-acquiredStaphylococcus aureusmusculoskeletalinfections in children.Pediatr Radiol. 2008;38:841–847.
44. Karmazyn B, Kleiman MB, Buckwalter K, et al. Acute pyomyositisof the pelvis: the spectrum of clinical presentations and MRfindings.Pediatr Radiol. 2006;36:338–343.
45. Marin C, Sanchez-Alegre ML, Gallego C, et al. Magnetic resonanceimaging of osteoarticular infections in children.Curr Probl DiagnRadiol. 2004;33:43–59.
46. Theodorou SJ, Theodorou DJ, Resnick D. MR imaging findings ofpyogenic bacterial myositis (pyomyositis) in patients with localmuscle trauma: illustrative cases.Emerg Radiol. 2007;14:89–96.
47. Damski GB, Garin EH, Ballinger WE, et al. Generalized non-suppurative myositis with staphylococcal septicemia. J Pediatr.1980;96:694–7.
48. Ameh EA (1999) Pyomyositis in children: analysis of 31 cases.Ann Trop Paediatr 19:263–265
49. Vij N, Ranade AS, Kang P, Belthur MV. Primary Bacterial Pyomyositis in Children: A Systematic Review. J Pediatr Orthop. 2021 Oct 1;41(9):e849-e854.
50. Song J, Letts M, Monson R (2001) Differentiation of psoasmuscle abscess from septic arthritis of the hip in children. ClinOrthop Relat Res 391:258–265
51. Armstrong DG, D’Amato CR, Strong ML (1993) Three cases ofstaphylococcal pyomyositis in adolescence, including one patientwith neurologic compromise. J Pediatr Orthop 13:452–455
52. Teague DC, Graney DO, Routt ML Jr. Retropubic vascular hazardsof the ilioinguinal exposure: a cadaveric and clinical study.J OrthopTrauma. 1996;10:156–159.
53. Karakurt L, Karaca I, Yilmaz E, et al. Corona mortis: incidence andlocation.Arch Orthop Trauma Surg. 2002;122:163–164.
54. Luhmann SJ, Jones A, Schootman M, et al. Differentiation betweenseptic arthritis and transient synovitis of the hip in children withclinical prediction algorithms.J Bone Joint Surg Am. 2004;86-A:956–962.
55. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis (myositis tropicans): current perspective. Postgrad Med J. 2004 May;80(943):267-70.
56. White S, Stopka S, Nimityongskul P, Jorgensen D. Transgluteal Approach for Drainage of Obturator Internus Abscess in Pediatric Patients. J Pediatr Orthop. 2017 Jan;37(1):e62-e66.
57. Hall RL, Callaghan JJ, Moloney E, Martinez S, Harrelson JM(1990) Pyomyositis in a temperate climate. Presentation, diag-nosis, and treatment. J Bone Joint Surg Am 72:1240–1244
58. Mignemi ME, Menge TJ, Cole HA, Mencio GA, Martus JE, Lovejoy S, Stutz CM, Schoenecker JG. Epidemiology, diagnosis, and treatment of pericapsular pyomyositis of the hip in children. J Pediatr Orthop. 2014 Apr-May;34(3):316-25.
59. Gupta G, Rabbi Q, Bohra V, Shah MM. Protrusio acetabulae as a sequel to septic arthritis of the hip with obturator internus pyomyositis. J Pediatr Orthop B. 2021 Nov 1;30(6):572-578.

How to Cite this Article:  Desai A, Ranade A, Belthur MV, Patwardhan S, Oka GA | Pelvic Pyomyositis in Children: Current Concepts Review | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 02-07.

(Article Text HTML)      (Full Text PDF)

Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature

Volume 7 | Issue 2 | May-August 2021 | Page: 20-23 | Ferdinand Nyankoue Mebouinz, Serge Etoundi Bekoé, Rose Bengono, Bertine Manuela Ndjeunga, Cathy Bebey Engome, Fabrice Arroye Betou

Authors: Ferdinand Nyankoue Mebouinz [1], Serge Etoundi Bekoé [1], Rose Bengono [1], Bertine Manuela Ndjeunga [2], Cathy Bebey Engome [3], Fabrice Arroye Betou [4]

[1] Department of Orthopaedic Trauma Surgery, Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
[2] Obstetrics Gynecology Clinic, Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal.
[3] Albert Royer Children’s Hospital University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar,Senegal.
[4] Department of Cardiovascular and Thoracic Surgery, University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar, Senegal.

Address of Correspondence
Dr Ferdinand Nyankoue Mebouinz,
Estrada do Forte do Alto Duque, 1449-005, Lisbon.
E-mail: ferdinandmebouinz@gmail.com


Background: Diagnosed and treated fairly early, children’s septic arthritis of the hip has few or no complications. Septic epiphyseal detachment of the hip in children is a rare complication due to delayed treatment. Unilateral forms have been reported, but bilateral involvement has never been described in the literature.
Case presentation: We report the case of an 8-year-old girl who presented with hip pain associated fever and diminished lower limb movements, approximately 4 months after the onset of symptoms. The diagnosis of bilateral septic epiphyseal detachment of the hips was made and computerized tomography (CT) scan revealed osteonecrosis of both femoral heads. The necrotic epiphyses required removal in order to control the infection.
Conclusion: This report highlights the importance of early diagnosis of septic arthritis of the hip in the neonatal period. Any delay in presentation, diagnosis or management can result in irrecoverable sequelae for the developing hip and seriously impact long-term function.
Keywords: Septic arthritis, Bilateral, Epiphysis detachment, Hip, Ablation.


1. Barthes X, Safar A, Seringe R. Treatment of septic arthritis in children. Arch Pediatr. 1 mai 1997;4(5):460‑3.
2. Badgley CE, Yglesias L, Perham WS, Snyder CH. STUDY OF THE END RESULTS IN 113 CASES OF SEPTIC HIPS. JBJS. Oct 1936; 18(4):1047.
3. Siffert RS. The Effect of Juxta-epiphyseal Pyogenic Infection on Epiphyseal Growth. Clin Orthop Relat Res. Oct 1957; 10:131.
4. Teklali Y, Ettayebi F, Benhammou M, El Alami ZF, El Madhi T, Gourinda H, et al.
Septic arthritis in infants and children about 554 cases. J Pediatrics and Childcare. 2002;15(3):137‑41. https://doi.org/10.1016/S0987-7983(02)83036-5
5. Coulibaly Y, Diakite AA, Keita M, Diakite I, Dembele M, Diallo G. Epidemiology and therapy of osteoarthritis in children. Mali Med. 2009; 24(3):7–10.
6. Aroojis AJ, Johari AN. Epiphyseal Separations After Neonatal Osteomyelitis and Septic Arthritis, Journal of Pediatric Orthopaedics. July 2000; 20(4):544.
7. Wyers MR, Samet JD, Mithal LB. Physeal separation in pediatric osteomyelitis. Pediatr Radiol. 2019;49:1229-33. https://doi.org/10.1007/s00247-019-04410-8.
8. Gajdobranski D, Petković L, Komarcević A, Tatić M, Marić D, Pajić M. [Septic arthritis in neonates and infants]. Med Pregl. June 2003; 56(5‑6):269‑75.
9. Mue DD, Salihu MN, Yongu WT, Ochoga M, Kortor JN, Elachi IC. Paediatric Septic Arthritis in a Nigerian Tertiary Hospital: A 5-Year Clinical Review. West Afr J Med. Aug 2018; 35(2):70‑4.
10. Atarraf K, Arroud M, Chater L, Afifi MA. Post-infectious femoral epiphysis detachment, about two cases. Pan Afr Med J. Aug 2014; 18:319. https://doi: 10.11604/pamj.2014.18.319.2242.
11. Schiavon R, Borgo A, Micaglio A. Septic physeal separation of proximal femur in a newborn. J Orthop Traumatol. Jun 2009; 10(2):105‑10.
12. Singh D, Krishna LG, Siddalingaswamy MK, Gupta V. Extra capsular extrusion of femoral capital epiphysis – an unusual presentation of sequelae of septic arthritis of hip. J Pediatr Orthop Part B. Nov 2011; 20(6):428‑31.
13. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health. 2005;41(1‑2):59‑62.https://doi.org/10.1111/j.1440-1754.2005.00538.x
14. RAMSEYER P, CAHUZAC JP. Acute osteo-articular infection of limbs in children. Rev Prat. 2001; 9:337‑45.
15. Rasigade J-P, Trouillet-Assant S, Laurent F. Staphylococcal bone and joint infections.Rev Francoph Lab. 2016;2016(480):33‑40. http://doi.org/10.1016/S1773-035X(16)30085-5
16. Sferopoulos NK, Papavasiliou VA. [Proximal epiphyseal separation of the femur in the newborn: early ultrasonic diagnosis]. Revue de Chirurgie Orthopedique et Reparatrice de L’appareil Moteur. 1994 ;80(4):338-341.
17. Laine JC, Denning JR, Riccio AI, Jo C, Joglar JM, Wimberly RL. The use of ultrasound in the management of septic arthritis of the hip. J Pediatr Orthop Part B. 2015;24(2):95‑8.
18. Le Saux N. Diagnosis and management of acute osteoarticular infections in children. Paediatr Child Health. 18 jul 2018;23(5):344‑52.
19. Akakpo-Numado GK, Gnassingbe K, Songne B, Amadou A, Tekou H. [Hip septic arthritis in young children with sickle-cell disease]. Revue de Chirurgie Orthopedique et Reparatrice de L’appareil Moteur. Feb 2008; 94(1):58‑63. http://doi.org/10.1016/j.rco.2007.09.004
20. Fernandez FF, Langendörfer M, Wirth T, Eberhardt O. Treatment of septic arthritis of the hip in children and adolescents. Orthopeadic Trauma Surgery. Dec 2013; 151 (6):596‑602.
21. Seivert V, Milin L, Coudane H, Delagoutte J-P, Martrille L. Medical conditions and arthroscopy Osteoarthritis, osteochondromatosis, synovitis septic and rheumatologic arthritis. In: Hulet C, Flurin P-H, editors. Arthroscopic Technics of Upper Limb. Paris: Elsevier Masson; 2013 p. 153‑63.
22. Daffe M, Sarr L, Gueye AB, Dembele B, Diouf AB, Sane A, et al. Hip Septic Arthritis: A Rare Complication. Int J Paediatr Orthop. 2019; 5(1):25‑6.
23. Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequelae and reconstruction after septic arthritis of the hip in infants. JBJS. 1990; 72(8):1150‑65.
24. Hunka L, Said SE, MacKenzie DA, Rogala EJ, Cruess RL. Classification and surgical management of the severe sequelae of septic hips in children. Clin Orthop Relat Res. 1982;171:30‑6.
25. Choi IH, Shin YW, Chung CY, Cho T-J, Yoo WJ, Lee DY. Surgical treatment of the severe sequelae of infantile septic arthritis of the hip. Clin Orthop. 2005; (434):102‑9.

How to Cite this Article:  Mebouinz FN, Bekoé SE, Bengono R, Ndjeunga BM, Engome CB, Betou FA | Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature |
International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 20-23.

(Article Text HTML)      (Download PDF)

Early Surgical Intervention in Children with a Suspected Diagnosis of Acute Septic Arthritis or Osteomyelitis: Is it Justified?

Volume 4 | Issue 2 | July-December 2018 | Page: 03-10 | Petnikota Harish

DOI- 10.13107/ijpo.2018.v04i02.011

Authors: Petnikota Harish

Vasudev Children’s Orthopaedics Centre, Bellary, Karnataka, India

Address of Correspondence
Dr. Petnikota Harish,
‘Vasudev’, Opp. Shanti Sishu Vihar School, Talur Road, Bellary – 583 103, Karnataka, India.
E-mail: harishportho@gmail.com


Context: Early surgical intervention is the key for good outcome in children with acute haematogenous osteomyelitis (AHO) or septic arthritis. Often there is an impasse to observe or intervene early when the diagnosis is inconclusive due to blunted clinical findings and equivocal investigations. Aim: This study is aimed at justifying early surgical intervention in these doubtful/suspected cases. Settings and
Design: This study was a retrospective review of AHO/septic arthritis treated by the author between August 2010 and January 2015. A new scoring system, haematogenous osteomyelitis and septic arthritis (HOMSA) score was developed to aid in classifying and decision-making. With a maximum score of 8, a score >6 in the absence of infection elsewhere or a score <6 with radiological evidence makes the diagnosis of AHO/septic arthritis definite. A score 6 without radiological evidence makes the diagnosis suspected/doubtful. Outcome was measured by a new discrete criterion for the upper and lower limbs.
Materials and Methods: The protocol was early surgical intervention in both the groups. In septic arthritis, open arthrotomy along with joint lavage and debridement was performed. In AHO, bone decompression with abscess drainage was performed. Initial parenteral administration of antibiotics was followed by oral antibiotic administration. Necessary adjuvant treatment was given.
Results: Thirty-four children with 40 sites of infection were identified. Among them, 50% were neonates. Only 4/40 children were treated conservatively. Following surgery, outcome was excellent-to-good in 92.8% of the children with doubtful/suspected diagnosis and 96.6% with definite infection. One child in each group who were treated surgically, and two children in the group with definite infection treated non-operatively had fair-to-poor outcomes. Conclusion: Early surgical intervention is justified even in children with a doubtful/suspected diagnosis of AHO or Septic Arthritis. The new scoring system, HOMSA Score, is a better tool to diagnose Acute septic arthritis or osteomyelitis, even with limited resources.
Keywords: Acute haematogenous osteomyelitis, Early surgery, Infants and children, Neonates, New outcome, Measure, New scoring system, Septic arthritis


1. Kuong EE, To M, Yuen MH, Choi AK, Fong CM, Chow W. Pitfalls in diagnosing septic arthritis in Hong Kong children: Ten years experience. Hong Kong Med J 2012;18:482-7.
2. Stans AA. Musculoskeletal infection. In: Weinstein SL, Flynn JM, editors. Lovell and Winter’s Paediatric Orthopaedics. 7th ed. Philadelphia: Lippincott Williams & Wilkins, Wolters Kluwer 2014. p. 369–425.
3. Herring JA, editor. Infections of the musculoskeletal system. Tachdjian’s Paediatric Orthopaedics. 4th ed. Philadelphia: Saunders Elsevier 2008. p. 2089-155.
4. Bennet OM, Namnyak SS. Acute septic arthritis of the hip joint in infancy and childhood. Clin Orthop Relat Res 1992; 281: 123-32.
5. Chen CE, Ko JY, Li CC, Wang CJ. Acute septic arthritis of the hip in children. Arch Orthop Trauma Surg 2001;121:521.
6. Kocher MS, Mandiga R, Murphy JM, Goldmann D, Harper M, Sundel R, et al. A clinical practice guideline for treatment of septic arthritis in children. J Bone Joint Surg Am 2003;85:994-9.
7. Lyon RM, Evanich JD. Culture-negative septic arthritis in children. J Pediatr Orthop 1999;19:655.
8. Morrey BF, Bianco AJ Jr, Rhodes KH. Septic arthritis in children. Orthop Clin N Am 1975;6:923-34.
9. Cole WG, Dalziel RE, Leitl S. Treatment of acute osteomyelitis in childhood. Bone Joint J 1982;64:218-23.
10. Wang CL, Wang SM, Yand YJ, Tsai CH, Liu CC. Septic arthritis in children: Relationship of causative pathogens, complications and outcomes. J Microbial Immunol Infect 2003;36:41-6.
11. Scoor RJ, Christofersen MR, Roberson WW Jr, Davidson RS, Rankin L, Drummond DS. Acute osteomyelitis in children: A review of 116 cases. J Pediatr Orthop 1990;10:649-52.
12. Klein DM, Barbera C, Gray ST, Spero CR, Perrier G, Teicher JL. Sensitivity of objective parameters in the diagnosis of paediatric septic hips. Clin Orthop Relat Res 1997;338:153-9.
13. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: An evidencebased clinical prediction algorithm. J Bone Joint Surg Am 1999;81: 1662-70.
14. Luhmann SJ, Jones A, Schootman M, Gordon JE, Schoenecker PL, Luhmann JD. Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms. J Bone Joint Surg 2004;86:956-62.
15. Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg 2004;86:1629-35.
16. Caird MS, Flynn JM, Leung YL, Millman JE, Joann GD, Dormans JP. Factors distinguishing septic arthritis from transient synovitis of the hip in children. J Bone Joint Surg Am 2006;88:1251-7.
17. Bonheffer J, Haeberle B, Schaad UB, Heininger U. Diagnosis of acute haematogenous osteomyelitis and septic arthritis: 20 years experience at the University Children’s Hospital Basel. Swiss MedWkly 2001;131:575-81.
18. Peltola H, Vahvanen V, Aalto K. Fever, C-reactive protein, and erythrocyte sedimentation rate in monitoring recovery from septic arthritis: A preliminary study. J Pediatr Orthop 1984;4:170-4.
19. Morrey BF, Peterson HS. Hematrogenous pyogenic osteomyelitis in children. Orthop Clin North Am 1976;6:935-51.
20. Segbefia M, Howard A. Acute Septic Arthritis and Osteomyelitis in Children − An African Perspective; 2013. Available from:
http:// ptolemy.library.utoronto.ca/sites/default/files/review/2010/February- Acuteseptic Arthritis and Osteomyelitis.pdf. [Last accessed on 2015 Apr].
21. Smith RL, Schurman DJ, Kajiyama G, Mell M, Gilkerson E. The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis. J Bone Joint Surg Am 1987;69:1063-8.
22. Nunn TR, Cheung WY, Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg Br 2007;89:100-6.
23. Welcon CJ, Long SS, Fisher MC, Alburger PD. Pyogenic arthritis in infants and children: A review of 95 cases. Pediatr Infect Dis 1986;5: 669-76.

How to Cite this Article:  Harish P Early Surgical Intervention | in Children with a Suspected Diagnosis of Acute Septic Arthritis or Osteomyelitis: Is it Justified? | July-December 2018; 4(2): 03-10.


(Article Text HTML)      (Download PDF)