This patient most likely has septic ahritis of the hip. Signs and symptoms associated with septic ahritis of the hip often are subtle and may be limited to a limp or refusal to walk. X-ray frequently shows a widening of the joint space. Septic ahritis of the hip requires immediate surgical drainage, because the blood supply to the femoral head may be compromised, causing permanent destruction to the joint. Drainage may be performed by needle aspiration or surgical excision. Cram stain and culture of the synol fluid should be obtained and appropriate antibiotic therapy begun.