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Clinical characteristics at the onset of peri-knee acute osteomyelitis in 56 children

Haiting Jia1,2, Weidong Mu1,3

  • 1First Clinical Medical College, Shandong University of Traditional Chinese Medicine.

Journal of Pediatric Orthopedics. Part B
|April 27, 2026
PubMed

Insights

Acute osteomyelitis near the knee in children often involves septic arthritis when the epiphysis is affected. Higher C-reactive protein (CRP) levels indicate methicillin-resistant Staphylococcus aureus (MRSA) infection, with levels over 92.785 mg/L being a key risk factor.

Area of Science:

  • Pediatric Orthopedics
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Acute osteomyelitis is a bone infection, commonly affecting the metaphysis but can involve the epiphysis in children.
  • Peri-knee osteomyelitis presents unique challenges due to proximity to the knee joint, potentially leading to septic arthritis.
  • Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in pediatric osteomyelitis, often associated with more severe disease.

Purpose of the Study:

  • To summarize the clinical characteristics of acute peri-knee osteomyelitis in children at disease onset.
  • To investigate the relationship between epiphyseal involvement, septic arthritis, and MRSA infection in pediatric peri-knee osteomyelitis.
  • To identify clinical predictors for MRSA infection in this patient population.

Main Methods:

  • Retrospective analysis of 56 children diagnosed with acute peri-knee osteomyelitis between July 2017 and 2024.
  • Classification of patients based on epiphyseal involvement, presence of knee septic arthritis, and MRSA infection status.
  • Comparison of clinical data (age, gender, onset duration, temperature, inflammatory markers) across groups.
  • Utilized receiver operating characteristic (ROC) curve analysis and logistic regression to evaluate MRSA infection predictors.

Main Results:

  • Epiphyseal involvement was associated with a higher incidence of concurrent septic arthritis (p<0.05).
  • Septic arthritis of the knee was more frequently observed in cases with epiphyseal osteomyelitis (p<0.05).
  • Patients with MRSA infection exhibited significantly higher C-reactive protein (CRP) levels compared to non-MRSA cases (p<0.001).
  • Logistic regression identified CRP > 92.785 mg/L as an independent risk factor for MRSA infection, with moderate diagnostic value (AUC=0.78).

Conclusions:

  • In pediatric peri-knee osteomyelitis, epiphyseal involvement and septic arthritis are closely interrelated.
  • Elevated CRP levels are indicative of MRSA infection in this cohort.
  • A CRP threshold of 92.785 mg/L can serve as a valuable indicator for high risk of MRSA infection, guiding early management decisions.

Keywords:
osteomyelitispediatricperi-knee

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