Shivvir Singh, Nidhi Kumari, Sumit Saad
Most children with septic arthritis achieved favorable functional recovery following timely surgical drainage and appropriate antimicrobial therapy. Delayed presentation, hip involvement, elevated inflammatory markers, methicillin-resistant S. aureus infection, and repeat surgical intervention were independently associated with poorer orthopedic outcomes.
INTRODUCTION: Pediatric septic arthritis is a limb-threatening orthopedic emergency that requires early diagnosis and prompt treatment to prevent permanent joint damage and functional disability. This study evaluated the clinical presentation, orthopedic outcomes, microbiological spectrum, and predictors of poor outcome in children with septic arthritis.
MATERIAL AND METHODS: A prospective observational study was conducted on 80 children (≤16 years) with septic arthritis at a tertiary care hospital over 24 months. Demographic characteristics, clinical findings, laboratory parameters, microbiological results, treatment modalities, and functional outcomes were recorded. Functional outcome at 6 months was assessed using the Modified Flynn Criteria. Factors associated with poor orthopedic outcomes were evaluated using multivariable logistic regression.
RESULTS: The mean age was 6.8 ± 3.9 years, and 61.3% of patients were male. The hip (38.8%) and knee (36.3%) were the most frequently affected joints. Synovial fluid culture was positive in 67.5% of cases, with Staphylococcus aureus being the predominant pathogen (methicillin-sensitive 35.0%, methicillin-resistant 13.8%). Arthrotomy was performed in 73.8% of patients. At 6 months, 83.8% achieved excellent or good functional outcomes, while 16.2% had fair or poor outcomes. Delayed presentation (>7 days) (adjusted odds ratios [AOR] 5.81; P = 0.005), hip involvement (AOR 3.28; P = 0.045), C-reactive protein >100 mg/L (AOR 4.63; P = 0.013), methicillin-resistant S. aureus infection (AOR 3.96; P = 0.034), and repeat surgical drainage (AOR 4.89; P = 0.019) were independent predictors of poor orthopedic outcome.
CONCLUSION: Most children with septic arthritis achieved favorable functional recovery following timely surgical drainage and appropriate antimicrobial therapy. Delayed presentation, hip involvement, elevated inflammatory markers, methicillin-resistant S. aureus infection, and repeat surgical intervention were independently associated with poorer orthopedic outcomes.