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Septic Arthritis of the Neonatal Hip: Acute Management and Late Reconstruction

Samora, Julie Balch MD, PhD; Klingele, Kevin MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: October 2013 - Volume 21 - Issue 10 - p 632–641
doi: 10.5435/JAAOS-21-10-632
Review Article

Septic arthritis of the hip in neonates is rare but can have devastating consequences. Presenting signs and symptoms may differ from those encountered in older children, which may result in diagnostic challenge or delay. Many risk factors predispose neonates to septic arthritis, including the presence of transphyseal vessels and invasive procedures. Bacterial infection of the joint occurs via hematogenous invasion, extension from an adjacent site, or direct inoculation. A strong correlation exists between younger age at presentation and severity of residual hip deformity. Diagnosis is based on clinical examination, laboratory markers, and ultrasound evaluation. Early management includes parenteral antibiotics and surgical drainage. Late-stage management options include femoral and pelvic osteotomies, trochanteric arthroplasty, arthrodesis, pelvic support procedures, and nonsurgical measures. Early diagnosis and management continues to be the most important prognostic factor for a favorable outcome in the neonate with septic arthritis.

From the Department of Orthopaedics, The Ohio State University (Dr. Samora), and the Department of Orthopedics, Nationwide Children's Hospital (Dr. Klingele), Columbus, OH.

Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Samora and Dr. Klingele.

© 2013 by American Academy of Orthopaedic Surgeons
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