A Clinical Analysis of Shoulder and Hip Joint Infections in Children

Background: Septic arthritis of the shoulder is a rare infection in healthy children. This infection requires prompt surgical drainage and antibiotic treatment. A delay in surgical intervention can result in damage to the articular surface of the glenohumeral joint, adjacent osteomyelitis, and possible growth disturbance. The clinical course of septic arthritis of the shoulder was compared with that of septic arthritis of the hip, a more common disease in children. Methods: We identified 9 children with infections of the glenohumeral joint who presented to our pediatric hospital between 2001 and 2007. The average age at presentation was 7 years (range: 7 mo to 12 y). These patients were compared with 14 selected patients treated for septic arthritis of the hip (mean age 7 y, range: 1 to 12 y). Surgical drainage was performed by open arthrotomy in each case. A retrospective review and analysis of the medical records, laboratory tests, and radiographs of these patients were performed. Results: Children with shoulder infections differed significantly (P < 0.05) from patients with hip infections with regard to temperature, white blood cell count, and erythrocyte sedimentation rate at the time of admission. The average time from the onset of symptoms to presentation was notably longer in the shoulder group compared with the hip group (P = 0.012). Adjacent osteomyelitis was found in 67% of the shoulders and 36% of the hips (P = 0.214). Children suffering from septic arthritis of the shoulder showed higher rates of repeat surgical drainage (P = 0.056) and extended hospitalizations (P = 0.028). The total duration of antibiotics was longer in the shoulder group (P = 0.059). Conclusions: Septic arthritis of the shoulder in the pediatric population often has a delayed presentation with a more complicated disease course than an infection of the hip. Children with shoulder infections require a longer duration of treatment and may experience a higher likelihood of skeletal complications. Level of Evidence: Level III, retrospective comparative study.