The diagnosis of pediatric septic arthritis of the hip can be elusive and can create significant anxiety for the treating orthopaedic surgeon. Septic arthritis must be considered when treating a child with an atraumatic history who refuses to bear weight on the affected extremity. The differential diagnosis is extensive, and differentiation between septic arthritis and transient synovitis in a child with an acutely irritable hip can be very challenging. Furthermore, delay in diagnosis of a septic hip can be detrimental to longterm outcomes.