What is it?

Septic arthritis or suppurative arthritis is an infection of the joint by a pus-forming bacteria. The bacteria enters the joint from the blood stream, and tends to occur in infants and young children.

If untreated, the bacteria causes destruction of the lining cartilage of the bones forming the joint, with eventual destruction of the joint. Tom Smith Arthritis is a form of septic arthritis of the hip joint in infants which destroys the whole head of the femur, being still completely cartilaginous at that age.

What are the symptoms?

Usually the presentation is acute pain and high fever. The child is often very sick-looking. The pain is very acute, and the child will not move the joint at all.

What does your doctor do about it?

Diagnosis is made clinically, with the help of blood tests and imaging techniques. A blood count reveals very high white blood cell count, with elevated sedimentation rate and C-reactive protein. The latter two tests indicate the level of acute inflammation in the body. Blood cultures may help to identify the responsible organism.

X-rays are usually normal in the early phase, although it may indicate the presence of fluid in the joint. A radionuclide bone scan using Gallium may indicate inflammation in the joint lining. An MRI may confirm the presence of fluid in the joint, and inflammation of the joint lining as well.

Aspiration of the joint is helpful, especially if pus is obtained. Culture could be undertaken to identify the organism involved.

Treatment consists of drainage of the joint. The knee can be drained adequately with arthroscopic lavage, but a hip needs to be drained by open surgery. Intravenous antibiotics are necessary to control this severe infection.