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

Shah, Hitesh; Belthur, Mohan; Ranade, Ashish; Ganjwala, Dhiren; Agarwal, Anil; Monsell, Fergal; Carpenter, Clare; Thacker, Mihir; Malone, Jason; Crawford, Haemish; Chand, Suresh; Sampath, Jayanth; Eastwood, Deborah; Wijayasinghe, Sunil; Sanghrajka, Anish; Singh, Kumar; MARANGOZ, SALİH; Khot, Abhay; Hamdy, Reggie; Bhaskar, Atul; Gopinathan, Nirmal; Gahukamble, Abhay; Gupta, Parmanand; Sheth, Binoti; Challawar, Nikhil; Chandankere, Vidyasagar; Tennakoon, Dimuthu; Fernandes, James; Horn, Anria; Rabbi, Qaisur; Shrestha, Anuj; Alam, Quazi; Baar Z., Alejandro; Baar Z., Alejandro

doi:10.1097/bpo.0000000000003471

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

Shah H., Belthur M. V., Ranade A., Ganjwala D., Agarwal A., Monsell F., ...Daha Fazla

Journal of Pediatric Orthopaedics, 2026 (SCI-Expanded, Scopus)

Yayın Türü: Makale / Tam Makale
Basım Tarihi: 2026
Doi Numarası: 10.1097/bpo.0000000000003471
Dergi Adı: Journal of Pediatric Orthopaedics
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
Anahtar Kelimeler: clinical management guidelines, Delphi consensus, hip joint infection, infants, pediatric orthopaedics, septic arthritis
Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet

Özet

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).