Management of septic arthritis of the hip joint in adults. A systematic review of the literature

Abstract

Background The septic arthritis of the hip is a complex condition characterized by a variety of clinical presentations, a challenging diagnosis and different surgical treatment options, including arthroscopy, resection arthroplasty and one and two-stage total hip replacement. Each technique reports variable results in terms of infection eradication rate. The aim of this systematic review is to compare the most relevant studies available in current literature and to assess if a better treatment outcome can be predicted based on the microbiology, history, and type of infection (active vs quiescent) of each case. Methods A systematic review of the literature was performed in accordance with the PRISMA guidelines, including the studies dealing with the treatment of hip septic arthritis in adult patients. Electronic databases, namely the MEDLINE, Scopus, and Web of Science, were reviewed using a combination of following keywords “septic arthritis” AND “hip joint” OR “hip” AND “adult”. Results The total number of patients included in this review was 1236 (45% of which females), for 1238 hips. The most common pathogen isolated was Staphylococcus aureus in its Methicillin-sensitive variant ranging from 2 to 37% of cases. Negative cultures were the second most common finding. It was also differentiated the type of infection of the hip, 809 and 417 patients with active and quiescent hip infection, respectively, were analyzed. Eradication rates for two-stage revision arthroplasty ranged between 85 and 100%, for one-stage approach between 94 and 100%, while for arthroscopic debridement/lavage between 89 and 100%. Conclusion Staphylococcus aureus is the most common microorganism isolated followed by culture negative infections. Arthroscopic, one and two stage procedures can be effective in the treatment of hip septic arthritis when the indication is consistent with the type of infection retrieved. Level of evidence IV, therapeutic study.

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“…Here, according to the possible application in Orthopaedics of the proposed coating aimed at implantable metallic devices, S. aureus was selected as target pathogen due its frequent involvement in joint infections. [ 33 ] Moreover, the possible specimens’ inhibition effect was tested toward both the planktonic and biofilm populations, representative of the floating and of the surface‐adherent components of the bacterial infection, respectively. Therefore, the focus was directed toward the different silver amount due to the preparation procedure in view of the ability to prevent biofilm adhesion onto the surface as well as to reduce the number of viable floating bacteria propagating the infection systemically.…”

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“…Its major complication is dislocation due to its intrinsic instability; in our case reports, there was a persistent fracture of the acetabulum, which did not allow the implanting of a hip spacer without significant risk [ 30 , 31 ]. Thus, we treated the fracture-related infection with a two-stage revision, while septic arthritis of the hip with a one-stage revision [ 14 , 32 ]. In the second stage, we planned to perform the definitive osteosynthesis and implant of the total hip arthroplasty after the second aggressive debridement with irrigation [ 33 ].…”

“…Furthermore, the presence of a bone gap with the rupture of the joint capsule can cause a continuity between the hip joint and pelvis. Therefore, an infection by contiguity spread is possible, and due to its proximity to the hip, septic arthritis could occur, so it should be excluded before the last surgical stage [ 11 , 12 , 13 , 14 ]. An accurate diagnosis must be obtained to conduct the correct treatment, and the pathogen’s isolation is mandatory to administer suitable antibiotic therapy.…”

No more tears from surgical site infections in interventional pain management

“…Mycobacterium tuberculosis is commonly found in the hematogenous infection. Treatments include arthroscopic debridement/lavage and one-stage or two-stage total hip arthroplasties, as well as a definitive antibiotic therapy [ 95 ].…”