Child Orthopedics


Frequently Asked Questions

My 10-year-old niece is in the hospital having her knee drained because of an infection in the joint. They said it usually clears up with one session of drainage. She'll be on antibiotics for awhile. What if it doesn't clear up? Then what?

Joint infection called infectious arthritis or septic arthritis can be cause for hospitalization. Early diagnosis and teatment is important for successful results. Antibiotics and surgical drainage are the gold standard for this condition. Without adequate treatment, complications can occur. The infection can travel deep into the bone causing osteomyelitis (bone infection) with the potential for bone deformity, joint dislocation, and arrest of bone growth that can result in limb length differences of the infected arm or leg. If unsuccessful, surgery to drain the pus and infection from the joint and clean it out may have to be repeated more than once. Response to treatment the first time depends on how long the infection was present before treatment was started. With more time to multiply, bacteria can reproduce and gain in strength. Some bacteria are simply more powerful or virulent. Left alone, they can do quite a bit of damage. Children with hip or knee septic arthritis are more likely to respond after one operation (compared with shoulder septic arthritis). That's probably because shoulder septic arthritis is harder to diagnose than hip septic arthritis. So, the diagnosis can be delayed. Failure to respond to treatment is recognized by persistent fever, continued large amounts of infectious drainage from the joint, and serum (blood) inflammatory markers unimproved. That's when a second (repeat) procedure is considered. Some children may require up to four procedures before the expected (successful) outcomes are achieved.

Mohan V. Belthur, MD, et al. A Clinical Analysis of Shoulder and Hip Joint Infections in Children. In Journal of Pediatric Orthopaedics. October/November 2009. Vol. 29. No. 7. Pp. 828-833.

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