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Updated: Dec 23, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Intracapsular pressure in children with septic arthritis of the hip
Pedro Gutiérrez Carbonell1, Enrique Ruiz Piñana, Jose Manuel Valiente Valero
1Unit of Orthopaedic Pediatric Surgery, Service of Orthopedic Surgery and Traumatology, Hospital Universitario de Alicante, Alicante, Spain.
Insights
Elevated hip joint pressure in septic arthritis can lead to avascular necrosis of the proximal femoral epiphysis (ANPFE). Urgent surgical drainage within 24 hours is crucial to reduce pressure and prevent ANPFE in children.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Surgical Critical Care
Background:
- Elevated intracapsular pressure in the hip can compromise retinacular blood supply, potentially causing avascular necrosis of the proximal femoral epiphysis (ANPFE) and growth disturbances.
- Septic arthritis of the hip is a serious condition requiring prompt diagnosis and management to prevent long-term complications.
Purpose of the Study:
- To investigate intra-articular pressure in pediatric patients diagnosed with septic arthritis of the hip.
- To explore potential correlations between intracapsular pressure and factors such as body weight, systemic blood pressure, and synovial fluid volume.
Main Methods:
- A cohort of 13 children with septic arthritis of the hip meeting specific clinical and ultrasonographic criteria were included.
- Intracapsular pressure was measured using an STIC self-calibrating monitoring system during arthrocentesis.
- Data collected included intracapsular pressure, aspirated synovial fluid volume, systemic blood pressure, and patient weight, with a mean follow-up of 6.3 years.
Main Results:
- The mean intracapsular pressure was 50.5 mmHg, with 61.5% of patients exhibiting pressure above 30 mmHg.
- No statistically significant correlation was found between intracapsular pressure and body weight, systemic blood pressure, or synovial fluid volume.
- Complications observed included coxa magna and Harris lines in 23% of patients.
Conclusions:
- Septic arthritis of the hip is associated with significantly elevated intracapsular pressure.
- Urgent surgical drainage, ideally within 24 hours of symptom onset, is recommended to mitigate the risk of ANPFE and other complications.
- Further research may be needed to identify other predictive factors for elevated intracapsular pressure in this population.
Abstract:
Elevated intracapsular pressure in the hip causes occlusion of the retinacular vessels and may result in avascular necrosis of the proximal femoral epiphysis (ANPFE) and growth disturbances. Our goal is to study intraarticular pressure in children with septic arthritis of the hip and its potential correlation with body weight, systemic blood pressure and the volume of synovial fluid aspirated from the joint. Thirteen septic arthritis of the hip were studied. Inclusion criteria: pain, limping, fever, leukocytosis, elevated C-reactive protein and ultrasonographic effusion >5 mm. Traumatic, inflammatory, rheumatic or tumoral origin were excluded. Mean age was 3.7 years. Girls were 58%. Mean time to articular drainage was 15 h. Arthrocentesis was performed. An STIC self-calibrating monitoring system with an error of ±1 mmHg was used. Measurements were taken: intracapsular pressure, volume of fluid aspirated, systolic and diastolic pressures and weight. Follow-up was 6.3 years. Descriptive and nonparametric tests were performed: U Mann-Whitney and Kruskal-Wallis. Statistical significance was P <0.05. Mean intracapsular pressure was 50.5 mmHg; fluid aspirated was 2.9 ml; systolic and diastolic pressures were 107.5 and 44.3 mmHg, respectively; weight was 16.2 kg. Intracapsular pressure exceeded 30 mmHg in eight children (61.5%) and was lower than 50 mmHg in 73%. Variables studied had no significance on intracapsular pressure. Complications: coxa magna in three patients (23%) and Harris lines in three (23%). Surgical drainage of septic arthritis of hip must be performed urgently, within the first 24 hours, to reduce the time with high intracapsular pressure and to avoid risk of ANPFE.
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