Septic arthritis of the shoulder in children in malawi: A randomised, prospective study of aspiration versus arthrotomy and washout

Abstract

We undertook a prospective study of 61 children in Malawi with septic arthritis of the shoulder. They were randomised into two groups, treated by aspiration (group 1, 31 patients) or arthrotomy (group 2, 30 patients). Both received antibiotics for six weeks. We studied the results of blood tests, microbiology, and the clinical and radiological outcome one year after diagnosis. Only one patient was sickle-cell positive and three were HIV-positive. Non-typhoidal Salmonella species accounted for 86% (19/22) of the positive joint cultures in group 1 and 73% (16/22) in group 2. Of the 33 radiographs available for review at follow-up at six months, 23 (70%) showed evidence of glenohumeral damage. There was no statistical difference in radiological outcome for the two groups. We devised and validated a scoring system, the Blantyre Septic Joint Score, for the assessment of joints based upon swelling, tenderness, function and range of movement. Despite the radiological changes only one of the 24 joints examined at one year had any deficit in these parameters. There was no statistical difference in the clinical outcome for the two treatment groups at any stage during the period of follow-up.

Chronic haematogenous osteomyelitis in children

“…Environmental factors such as a hot climate and seasonal variations may also contribute to high levels of musculoskeletal sepsis. 12 Sickle cell disease is common in sub-Saharan Africa, and these patients are particularly susceptible to acute skeletal infections, often caused by a non-typhoid Salmonella species. 13,14 …”

SEIP–SERPE–SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis

“…1,4,5,17---20 In a randomised study of children with arthritis of the shoulder, for example, no differences were found in prognosis or length of stay in patients treated with aspiration versus arthrotomy. 1 As for the hip, there are also studies that support a favourable outcome in children treated with aspiration/irrigation. 5 The following are factors that the authors consider indicate a poor prognosis and thus a need for open surgery: symptoms lasting at least six days, CRP >10 mg/dL, >15,000 neutrophils/mm 3 and erythrocyte sedimentation rate (ESR) >50 mm/h.…”

Arthrite septique de hanche de l’enfant : évaluation du traitement par aspiration à l’aiguille suivie de lavage

“…Nos résultats satisfaisants nous confortent d'utiliser en première intention l'aspiration du pus par simple ponction, comme le confirment Nord et al [27] et Smith et al [28], qui ne trouvent aucune différence entre les différentes méthodes de lavage (aspiration, arthroscopie ou arthrotomie). Qu'elle soit menée par voie obturatrice ou par voie antérieure, la ponction-lavage nous a donné entière satisfaction dans la majorité des cas.…”