Paeds Vivas · investigations-procedures-and-technology
Joint aspiration — branching viva
Branching viva on joint aspiration (arthrocentesis) in children: the septic-versus-transient-synovitis prediction rule, ultrasound-guided technique for the deep hip, synovial fluid interpretation, the relative contraindications, and the haemophilia scenario.
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RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Emergency department: a 3-year-old febrile child refuses to walk and holds the right hip flexed and abducted, with a raised C-reactive protein and a hip effusion on ultrasound. The examiner asks how you score the risk, how you prepare for and perform the aspiration, and what the fluid will tell you — then branches to the haemophilic child with a swollen knee, to the interpretation of a low cell count, and finally to the complications and aftercare.
Opening question
This 3-year-old febrile child refuses to walk and holds the right hip flexed and abducted, with a raised C-reactive protein and a hip effusion on ultrasound. Score the risk of septic arthritis, and tell me what the score dictates about your next step. [1]
References4ShowHide
- [1]Kocher MS, Zurakowski D, Kasser JR Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm J Bone Joint Surg Am, 1999.PMID 10608376
- [2]Kocher MS, Mandiga R, Zurakowski D, et al Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children J Bone Joint Surg Am, 2004.PMID 15292409
- [3]Nannini A, Giorgino R, Bianco Prevot L, et al Septic arthritis in the pediatric hip joint: a systematic review of diagnosis, management, and outcomes Front Pediatr, 2023.PMID 38188916
- [4]Tantillo TJ, Boudreaux S, Katsigiorgis G Arthrocentesis StatPearls, 2026.PMID 32491737