A systematic review of the optimal drainage technique for septic hip arthritis in children

Abstract

Introduction: The hip is one of the most commonly affected joints in paediatric septic arthritis. Drainage can be performed using arthrocentesis (articular needle aspiration), arthroscopy or arthrotomy. The objective of this systematic review was to identify the most effective drainage technique for septic hip arthritis in the paediatric population. Materials and methods: The electronic MEDLINE, EMBASE and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the paediatric hip. Outcome parameters were additional drainage procedures, clinical outcomes and radiological sequelae. The quality of each of the included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) score. Results: Out of 2428 articles, 19 studies with a total of 406 hip joints were included in the systematic review. Additional arthroscopy or arthrotomy was performed in 15% of the hips treated with arthrocentesis, in 14% after arthroscopy and in 3% after arthrotomy. Inferior clinical outcomes and more radiological sequelae were seen in patients treated with an arthrotomy. A meta-analysis could not be performed due to the diversity and low quality of the studies (MINORS median 4 [range 2–15]). Conclusions: This systematic review gives a comprehensive overview of the available literature on treatment for septic hip arthritis in children. Arthrocentesis and arthroscopic procedures may have a higher risk of additional drainage procedures in comparison with arthrotomy. However, arthrotomy might be associated with inferior outcomes in the longer term. The included studies are diverse and the scientific quality is generally low.

Developments in diagnosis and treatment of paediatric septic arthritis

“…An arthrotomy gives a good overview of the joint and allows a thorough irrigation, but a disadvantage is a larger incision with more scar tissue. The anterior approach is the most mentioned approach for arthrotomy in paediatric septic hip arthritis[ 6 ].…”

“…Recent systematic reviews showed a clear overview of the literature on drainage techniques for septic knee and hip arthritis in children[ 5 , 6 ]. It was concluded that knee arthroscopy might have a lower risk of additional drainage procedures as compared to arthrocentesis and arthrotomy in paediatric septic knee arthritis[ 5 ].…”

“…In septic hip arthritis, arthrocentesis and arthroscopic procedures may have a higher risk of additional drainage procedures in comparison with arthrotomy. Nonetheless, arthrotomy in septic hip arthritis might be associated with inferior outcomes on the long term[ 6 ]. However, the studies about the optimal drainage procedure of the several joints were diverse and the scientific quality was generally low[ 5 , 6 ].…”

“…Nonetheless, arthrotomy in septic hip arthritis might be associated with inferior outcomes on the long term[ 6 ]. However, the studies about the optimal drainage procedure of the several joints were diverse and the scientific quality was generally low[ 5 , 6 ].…”

“…In 2020, a systematic review was published that stated the test characteristics of history, physical examination and laboratory and image investigations in the evaluation for septic arthritis in children presenting with an acute nontraumatic limp[ 4 ]. Recently, we published two systematic reviews with a clear overview of the literature on drainage techniques for septic knee and hip arthritis in children[ 5 , 6 ]. In this evidence-based current concept review we therefore provide an update on the diagnostic workup and treatment of paediatric septic arthritis.…”