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The Prevalence of Pediatric Septic Arthritis of the Hip with Concomitant Osteomyelitis: A Retrospective Study of 58
Ahmer Ahmad Khan1,2,3, Elio Paris1,2, Viola Sbampato1
1Division of Paediatric Orthopedics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Background:
This observational study systematically used magnetic resonance imaging (MRI) to determine the prevalence of concomitant osteomyelitis and its influence on clinical outcomes in cases of pediatric septic arthritis (SA) of the hip.
Methods:
We retrospectively analyzed the demographic, clinical, microbiological, and radiographic data of 58 children treated for SA of the hip who underwent systematic MRI between 2000 and 2025. Patients were categorized into 2 groups: isolated septic arthritis and septic arthritis with concomitant osteomyelitis. The clinical and laboratory parameters, causative pathogens, and treatments were compared between the groups.
Results:
Concomitant osteomyelitis was identified with MRI in 43% (25) of the 58 patients, while radiographs detected it in only 16%. Demographic, clinical, and inflammatory parameters were statistically similar between the groups. Kingella kingae was the most commonly identified pathogen (37.9%), and Staphylococcus aureus and Streptococcus spp. were more frequently associated with repeat surgery. No significant differences in complication rates, treatment duration, or outcomes were found between the groups.
Conclusions:
The systematic use of MRI revealed concomitant osteomyelitis in >40% of cases of pediatric SA. However, the presence of osteomyelitis was not associated with worse outcomes, suggesting that factors related to the microorganism profile or virulence must contribute substantially to disease severity. Nonetheless, MRI should be considered early in any diagnostic work-up of pediatric SA of the hip.
Level Of Evidence:
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Insights
Magnetic resonance imaging (MRI) found osteomyelitis in over 40% of pediatric hip septic arthritis (SA) cases. However, this did not worsen patient outcomes, highlighting the importance of early MRI in diagnosis.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Radiology
Background:
- Pediatric septic arthritis (SA) of the hip is a serious condition.
- Concomitant osteomyelitis can complicate SA, potentially affecting outcomes.
- Early and accurate diagnosis is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of osteomyelitis in pediatric hip SA using MRI.
- To evaluate the influence of concomitant osteomyelitis on clinical outcomes in pediatric hip SA.
- To assess the diagnostic utility of MRI compared to radiography for detecting osteomyelitis in pediatric hip SA.
Main Methods:
- Retrospective analysis of 58 children with hip SA treated between 2000 and 2025.
- Systematic MRI was performed for all patients.
- Patients were grouped into isolated SA and SA with concomitant osteomyelitis for comparison.
Main Results:
- MRI identified concomitant osteomyelitis in 43% of cases, significantly higher than radiography (16%).
- Demographic, clinical, and inflammatory markers were similar between groups.
- No significant differences in complication rates or treatment outcomes were observed between groups, though certain pathogens were linked to repeat surgery.
Conclusions:
- Systematic MRI is highly effective in detecting concomitant osteomyelitis in pediatric hip SA.
- The presence of osteomyelitis did not negatively impact clinical outcomes in this cohort.
- Early MRI is recommended for the diagnostic work-up of pediatric hip SA to accurately identify concomitant osteomyelitis.
