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Suspected native hip septic arthritis — MSRA MCQ

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HardHip and GroinSuspected native hip septic arthritisMSRA

A 58-year-old man presents urgently with 18 hours of severe atraumatic left groin pain. He cannot weight-bear and keeps the hip flexed. He has rheumatoid arthritis treated with adalimumab and methotrexate. He had dysuria treated with oral antibiotics 10 days ago, which has resolved. He is alert and haemodynamically stable. Temperature is 37.2°C, pulse 94 beats/minute and blood pressure 128/76 mmHg. The hip has no erythema or visible swelling, but passive flexion and rotation cause marked pain. There is no lumbar tenderness, focal neurological deficit or calf swelling. What is the most appropriate immediate management in general practice?

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Correct answer: C — Arrange immediate hospital assessment for suspected septic arthritis and withhold antibiotics until microbiological samples and joint aspiration have been obtained

This presentation requires emergency hospital assessment for suspected native-hip septic arthritis. The decisive features are acute severe monoarticular pain with inability to weight-bear, pronounced pain on passive movement, recent possible bacteraemia from urinary infection, and immunosuppression with adalimumab and methotrexate. A normal temperature does not safely exclude joint sepsis, particularly in an immunosuppressed person. The absence of visible swelling is also unhelpful for a deep joint such as the hip. In this stable patient, antibiotics should not be given in the surgery before diagnostic samples are obtained, because blood cultures and urgent image-guided joint aspiration are needed to identify the organism and direct treatment. Hospital assessment is required because hip aspiration and possible operative drainage are not primary-care interventions. A is unsafe because oral treatment and delayed review risk rapid joint destruction. B and C inappropriately route a time-critical suspected infection through outpatient pathways; plain radiography or ultrasound may support assessment but must not delay admission. D recognises the need for emergency care but prematurely gives antibiotics before cultures and aspiration in a stable patient, reducing diagnostic yield. If he were septic or transfer were substantially delayed, immediate antimicrobial treatment after obtaining any feasible cultures would take priority.

Reference: Septic Arthritis / Osteomyelitis (Native joint, not diabetic ulcer associated) (Last reviewed 01 February 2026) — https://www.rightdecisions.scot.nhs.uk/antimicrobial-prescribing-nhs-borders/adult-hospital-guidance/musculoskeletal-and-joint/septic-arthritis-osteomyelitis-native-joint-not-diabetic-ulcer-associated/ Septic arthritis (Last reviewed 23 March 2023) — https://www.nhs.uk/conditions/septic-arthritis/ Lower limb (2025) — https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/physiotherapy/msk-physiotherapy/lower-limb/