The evaluation of a septic hip involves a combination of clinical assessment, laboratory investigations, and imaging studies.
Clinical assessment
- History and physical examination: The initial evaluation includes a thorough history and physical examination. Symptoms such as joint pain, swelling, and fever may be present. Joint tenderness and effusion are significant findings that can aid in the diagnosis of septic arthritis
Laboratory investigations
- Synovial fluid analysis: Aspiration of the joint and analysis of the synovial fluid is a crucial step in the evaluation. The fluid is analyzed for white blood cell count, differential, and culture. In the context of tuberculosis arthritis, synovial fluid and biopsies should be analyzed for acid-fast bacilli stain, mycobacterial culture, and nucleic acid amplification test
- Core biopsy: In certain cases, a core biopsy may be performed to confirm the resolution of sepsis before revision hip arthroplasty
Imaging studies
- Plain radiographs: Plain joint radiographs should screen for preexisting conditions such as fracture, osteomyelitis, osteoarthritis, or implants. They can also serve as a reference for future monitoring
- Ultrasound, CT, or MRI: These imaging modalities can be used to detect joint effusion and surrounding abscesses. MRI is particularly useful for diagnosing specific joints, such as the sacroiliac joint, and to detect adjacent osteomyelitis
- CT-guided joint aspiration: In not easily accessible joints, CT-guided joint aspiration can be considered
In conclusion, the evaluation of a septic hip requires a comprehensive approach involving clinical assessment, laboratory investigations, and imaging studies. This approach aids in the accurate diagnosis and management of this potentially serious condition.