- Diff Dx
- Evaluation: (before antibiotics are infused):
- synovial fluid analysis
- culture & gram's stain;
- leukocyte count
- glucose and viscosity (both decreased w/ infection);
- blood culture, CBC, CRP, & sed rate
- radiographs (and possibly ultrasound):
- need to rule out concomitant metaphyseal osteomyelitis;
- misc: bone scans
- Treatment:
- based on antimicrobial suseptabilities as well as patient age:
- less than 3 months
- from 6 mo to 2 yrs
- greater than 2 yrs;
- drainage:
- drainage can be provided by repeated closed needle aspiration, arthroscopy, or arthrotomy;
- septic hip demands open drainage;
- if joint cannot be adequately drained because of loculations or if the joint is not responding clinically with gradually decreasing synovial-fluid leukocyte counts and negative cultures, open surgical drainage will be necessary