Management of pediatric hip infections - A narrative review

Spectrum of hip infections in children include septic arthritis, proximal femoral and pelvic osteomyelitis, and pericapsular pyomyositis. Infection from one site can extend to adjacent structures, resulting in overlapping and often indistinguishable clinical picture. Clinical and laboratory parameters, including fever, inability to bear weight and elevated inflammatory markers are helpful in distinguishing infectious from non-infectious causes of hip pain. However, they cannot reliably differentiate the site or extent of infection. Blood and local aspirate cultures are crucial for identifying causative organisms, yet a significant proportion of cases are culture negative. Aggressive treatment is required even in culture negative cases if clinical, laboratory, and imaging findings are consistent with infection. Magnetic resonance imaging (MRI) is the modality of choice for defining the site and extent of disease, detecting multiple foci, and guiding surgical planning. Ultrasonography, although less sensitive and specific, may be helpful in settings where MRI is unavailable, especially for identifying joint effusion and guiding diagnostic aspiration. Management hinges on early initiation of appropriate empirical antibiotics, tailored subsequently to culture results, along with drainage of all foci of purulent collections. Misdiagnosis or delayed treatment can result in multiple surgical procedures and sequalae including hip dislocation, involvement of proximal femur growth plate, chondrolysis and partial or complete resorption of femoral head leading to long-term disability. In this narrative review, diagnosis, imaging features and management strategies are discussed under relevant headings. For this, a PubMed search was conducted from January 1990 to August 2025 using the terms "pediatric hip septic arthritis," "pediatric hip osteomyelitis," and "pediatric hip pyomyositis." Of 575 articles identified, 48 relevant studies were included. In addition, one seminal study from 1978 was included because of its clinical relevance.