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Acute hematogenous osteomyelitis most frequently occurs in children, generally around 6 to 9 years of age. If it occurs in early infancy, the infection usually involves both the bone and the joint, nearly simultaneously. Neonatal osteomyelitis is another presentation, with an osteomyelitic focus in the metaphysis. We report a case of septic arthritis following osteomyelitis of the hip joint in a neonate caused by a virulent pathogenic organism. Despite late diagnosis and treatment, outcome was very satisfactory with few sequelae for the joint and epiphysis. It should be emphasized that early diagnosis, with prompt and adequate treatment is essential to achieve good outcome. We discuss this case and present a review of the literature.

A retrospective study was done to review the clinical experience of septic arthritis and osteomyelitis in the newborns in our centre. Case records of all the neonates born from January 1989 to August 1994 and those admitted to outborn nursery from 1985 to 1993 were reviewed. Diagnosis of septic arthritis/osteomyelitis was made in the presence of relevant clinical signs and supported by positive culture from blood or joint fluid and abnormal X-ray or ultrasound findings. The incidence of septic arthritis and osteomyelitis among inborn babies was 1 in 1500. There were 25 neonates with mean gestational age 34.5 (range 27-40) weeks and mean birth weight 2269 (range 990-4750) gms. Limitation of movement (64%) and local swelling (60%) were commonest presentations. A total of 33 joints were involved in 25 babies. Eight babies (32%) had multiple joint involvement. Hip and knee were the most commonly involved joints (48% each). In 19 babies (76%) joint involvement occurred in association with a generalized septicemic illness while 6 babies (24%) had localised signs and symptoms. Joint aspirate was positive for gram stain or culture in 12 (48%) and 10 babies (40%) had positive blood culture. Klebsiella pneumoniae and Staphylococcus aureus were commonest isolates. Radiological changes were seen in 13 (52%) babies. All were treated with appropriate antibiotics and open surgical drainage was done in 5 (20%) cases. Bone and joint infections are important complications in sick septicemic neonates and need early diagnosis, appropriate management with antibiotics, surgical drainage in selected cases to prevent long term morbidity.