Unifying Concepts

Kocher Criteria for Septic Arthritis

Kocher identified four predictive factors that can aid in differentiating septic arthritis of the hip from transient synovitis. Fever >38.5 C, inability to bear weight, serum white blood cell count (WBC) >12,000/mm3, and an erythrocyte sedimentation rate (ESR) ≥40 mm/h were found to be associated with septic arthritis of the hip. The presence of all four factors was 99.6% predictive of septic hip.

Kocher Criteria for Septic Arthritis

  1. Fever >38.5 C
  2. Inability to bear weight
  3. Serum white blood cell count (WBC) >12,000/mm3
  4. Erythrocyte sedimentation rate (ESR) ≥40 mm/h

Likelihood of septic arthritis: 0 point, 0.20%; 1 point, 3%; 2 points, 40%; 3 points, 93%; 4 points, 99.6%



  1. Bisht RU, Burns JD, Smith CL, Kang P, Shrader MW, Belthur MV. The modified Kocher criteria for septic hip: Does it apply to the knee? J Child Orthop. 2022 Jun;16(3):233-237. [Medline]
  2. 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 Dec;81(12):1662-70. [Medline]


Created Apr 18, 2023.


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