Diagnosis of hip pyarthritis includes:

 Taking into account ability to bear weight, fever, leukocyte count, and erythrocyte sedimentation rate, the predicted probability of septic arthritis is 3% for one predictor, 40% for two, 93% for three, and 99.6% for four (Kocher et al., 1999).

 C-reactive protein less than 1 mg/dl has an 87% negative predictive value (Levine et al., 2003).

 Imaging plays a relatively small role in the diagnosis of hip pyarthritis.

 Radiographs may show displacement of the proximal femoral epiphysis by effusion, as seen in the left proximal femoral subluxation in Figure 1. In addition, they may exclude other causes of hip pain and stiffness.

 Ultrasonography may determine quantitatively the presence and size of hip effusion, and qualitatively the nature of such an effusion (Zieger et al., 1987).

 Magnetic resonance imaging is useful for differential diagnosis of an extracoxal source of infection, such as psoas abscess. Figure 2 demonstrates an abscess within the left iliacus on coronal (Fig. 2A) and axial (Fig. 2B) magnetic resonance imaging.

 The most common surgical approach is the anterior approach of Smith-Petersen (developed originally for arthroplasty).

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