International Delphi Consensus on the Diagnosis and Management of Septic Arthritis of the Hip in Prewalking Children

BACKGROUND: Septic arthritis of the hip in infants and prewalking children is a surgical emergency that can lead to rapid joint destruction and long-term sequelae. Despite its urgency, diagnostic and management practices vary considerably, and high-quality comparative evidence remains limited. This study aimed to develop expert consensus on the key principles of diagnosis and management using a modified Delphi methodology. METHODS: A working group of 3 pediatric orthopaedic surgeons developed 20 statements addressing clinical diagnosis, imaging, medical and surgical management, postoperative care, and follow-up. Forty-five fellowship-trained pediatric orthopaedic surgeons from 12 countries, including 15 from high-resource and 30 from low-resource countries, were invited to participate. Thirty-five completed round 1, and 32 completed round 2. Consensus was defined a priori as ≥70% agreement. Statements that did not reach consensus were revised and redistributed in round 2. RESULTS: Eight statements reached consensus in round 1, including universal laboratory testing, avoidance of antibiotic-only treatment, preference for anterior arthrotomy, and early surgical decompression. Twelve statements were revised for round 2, of which 7 subsequently achieved consensus. The final consensus emphasized: (1) pseudoparalysis with pain on passive movement as the most important clinical sign; (2) selective but important use of MRI in cases of diagnostic uncertainty or suspected osteomyelitis; (3) open anterior arthrotomy as the preferred surgical approach; (4) immobilization only for unstable hips; (5) an antibiotic duration of ≤4 weeks for isolated septic arthritis; and (6) a minimum follow-up of 2 years. Five statements did not reach consensus. CONCLUSION: This international Delphi study provides expert-derived recommendations for the diagnosis and management of septic arthritis of the hip in prewalking children. These consensus statements offer a practical framework for clinical decision-making and identify key areas requiring further research, including the role of routine ultrasound, synovial fluid analysis, and postoperative care. LEVEL OF EVIDENCE: Level V (expert opinion/consensus statement).

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Journal
Journal of Pediatric Orthopaedics
Published
2026-09-17
DOI
https://doi.org/10.1097/bpo.0000000000003471
Primary Topic
Orthopedic Infections and Treatments
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article
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article

International Delphi Consensus on the Diagnosis and Management of Septic Arthritis of the Hip in Prewalking Children

Suresh Chand, Salıh Marangoz, Qaisur Rabbi, Dimuthu Tennakoon et al.
Journal of Pediatric Orthopaedics
Orthopedic Infections and Treatments
article

International Delphi Consensus on the Diagnosis and Management of Septic Arthritis of the Hip in Prewalking Children

Suresh Chand, Salıh Marangoz, Qaisur Rabbi, Dimuthu Tennakoon, C W Carpenter, Dhiren Ganjwala, Vidyasagar Chandankere, Mihir M. Thacker, Dr Ashish Ranade, Mohan V. Belthur, Hitesh Shah, A Horn, Parmanand Gupta, Anil Agarwal, Anuj Shrestha, Abhay Khot, James A. Fernandes, Jayanth S. Sampath, Deborah Eastwood, Reggie Hamdy, Abhay Gahukamble, Quazi Alam, Fergal Monsell, Haemish Crawford, Nirmal R. Gopinathan, Anish Sanghrajka, Nikhil Challawar, Atul Bhaskar, Jason Malone, Binoti Sheth, Sunil Wijayasinghe, Kumar A. Singh, Alejandro Baar Z.
article en

Abstract

BACKGROUND: Septic arthritis of the hip in infants and prewalking children is a surgical emergency that can lead to rapid joint destruction and long-term sequelae. Despite its urgency, diagnostic and management practices vary considerably, and high-quality comparative evidence remains limited. This study aimed to develop expert consensus on the key principles of diagnosis and management using a modified Delphi methodology. METHODS: A working group of 3 pediatric orthopaedic surgeons developed 20 statements addressing clinical diagnosis, imaging, medical and surgical management, postoperative care, and follow-up. Forty-five fellowship-trained pediatric orthopaedic surgeons from 12 countries, including 15 from high-resource and 30 from low-resource countries, were invited to participate. Thirty-five completed round 1, and 32 completed round 2. Consensus was defined a priori as ≥70% agreement. Statements that did not reach consensus were revised and redistributed in round 2. RESULTS: Eight statements reached consensus in round 1, including universal laboratory testing, avoidance of antibiotic-only treatment, preference for anterior arthrotomy, and early surgical decompression. Twelve statements were revised for round 2, of which 7 subsequently achieved consensus. The final consensus emphasized: (1) pseudoparalysis with pain on passive movement as the most important clinical sign; (2) selective but important use of MRI in cases of diagnostic uncertainty or suspected osteomyelitis; (3) open anterior arthrotomy as the preferred surgical approach; (4) immobilization only for unstable hips; (5) an antibiotic duration of ≤4 weeks for isolated septic arthritis; and (6) a minimum follow-up of 2 years. Five statements did not reach consensus. CONCLUSION: This international Delphi study provides expert-derived recommendations for the diagnosis and management of septic arthritis of the hip in prewalking children. These consensus statements offer a practical framework for clinical decision-making and identify key areas requiring further research, including the role of routine ultrasound, synovial fluid analysis, and postoperative care. LEVEL OF EVIDENCE: Level V (expert opinion/consensus statement).

Journal of Pediatric Orthopaedics
Royal Children's Hospital (AU), Maharashtra University of Health Sciences (IN), University of Cape Town (ZA), Manipal Academy of Higher Education (IN), Christian Medical College, Vellore (IN), Universidad de Los Andes, Chile (CL), Bangladesh Medical University (BD), Great Ormond Street Hospital (GB), Norfolk and Norwich University Hospitals NHS Foundation Trust (GB), Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College (IN), University Hospitals Bristol NHS Foundation Trust (GB), Lady Ridgeway Hospital for Children (LK), Shriners Hospitals for Children - Canada (CA), Royal National Orthopaedic Hospital (GB), King George's Medical University (IN), Ahmedabad Civil Hospital (IN), Acıbadem University (TR), Government Medical College and Hospital (IN), Sunshine Hospitals (IN), Nemours Children's Health System (US), Orthopaedic Specialty Clinic (US), Noah's Ark Children's Hospital for Wales (GB), Deenanath Mangeshkar Hospital and Research Center (IN), Royal National Orthopaedic Hospital NHS Trust (GB), Sheffield Children's NHS Foundation Trust (GB), Phoenix Children's Hospital (US), Centre for the Rehabilitation of the Paralysed (BD), Starship Children's Health (NZ), Rainbow Children's Hospital (IN), Chacha Nehru Bal Chikitsalaya (IN), Red Cross War Memorial Children's Hospital (ZA), Sheffield Children's Hospital (GB), University College London (GB), Post Graduate Institute of Medical Education and Research (IN)
Partnerships for the goals
Openalex Percentile: Top 8%
Orthopedic Infections and Treatments
DOIOpen Access PDFOpenAlex
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