Surgical treatment options for septic arthritis of the hip in children

Xu, Gang; Spoerri, Muriel; Rutz, Erich

doi:10.4103/0189-6725.181621

Cited by 16 publications

(4 citation statements)

References 24 publications

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“…With an arthrotomy there is a better overview of the joint and sufficient irrigation can be performed, but it can possibly lead to prolonged recovery, a higher risk of avascular necrosis, and associated problems such as stiffness of the joint. 15 However, in the included studies these differences were not found. In the earlier published studies it was not specified whether the surgeons only performed an aspiration or also did a lavage or washout through the needle.…”

Section: Discussionmentioning

confidence: 89%

Aspiration or arthrotomy for paediatric septic arthritis of the shoulder and elbow: a systematic review

et al. 2021

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Upper extremity arthritis in children can be treated with joint aspiration, arthroscopy or arthrotomy, followed by antibiotics. The literature seems inconclusive with respect to the optimal drainage technique. Therefore, the objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the upper extremity in children. Two independent investigators systematically searched the electronic MEDLINE, EMBASE and Cochrane databases for original articles that reported outcomes of aspiration, arthroscopy or arthrotomy for septic arthritis of the paediatric shoulder or elbow. Outcome parameters were clinical improvement, need for repetitive surgery or drainage, and complications. Out of 2428 articles, seven studies with a total of 171 patients treated by aspiration or arthrotomy were included in the systematic review. Five studies reported on shoulder septic arthritis, one study on elbow septic arthritis, and one study on both joints. All studies were retrospective, except for one randomized prospective study. No difference was found between type of treatment and radiological or clinical outcomes. Aspiration of the shoulder or elbow joint required an additional procedure in 44% of patients, while arthrotomy required 12% additional procedures. Conclusion: Both aspiration and arthrotomy can achieve good clinical results in children with septic arthritis of the shoulder or elbow joint. However, the scientific quality of the included studies is low. It seems that the first procedure can be aspiration and washout and start of intravenous antibiotics, knowing that aspiration may have a higher risk of additional drainage procedures. Cite this article: EFORT Open Rev 2021;6:651-657. DOI: 10.1302/2058-5241.6.200122

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Section: Discussionmentioning

confidence: 89%

Aspiration or arthrotomy for paediatric septic arthritis of the shoulder and elbow: a systematic review

et al. 2021

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“…El-Sayed et al [14] found a success rate similar to open arthrotomy and a significantly shorter hospitalization duration using hip arthroscopy drainage and irrigation to treat septic hip arthritis in children. However, the use of hip arthroscopy in children requires special training and an experienced orthopedic surgeon in the field, as it could prove technically challenging [21].…”

Section: Discussionmentioning

confidence: 99%

Preliminary results: continuous double luminal catheter drainage for the management of septic hip arthritis in children

Essa

Asa'af

Shtarker

2021

Journal of Pediatric Orthopaedics B

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Septic arthritis in children is considered an orthopedic surgical emergency, which requires prompt intervention to prevent later sequela. In the last decades, several minimal invasive techniques were suggested as an alternative to the standard treatment of septic arthritis in the pediatric hip via open arthrotomy. We aimed to investigate the efficacy and safety of a new minimal invasive techniquedouble luminal catheter drainage (DLDC)-in treating septic hip arthritis in children. Retrospective case series analysis was performed on all patients 1-18 years of age diagnosed with septic hip arthritis and treated by the new suggested minimal invasive technique between the years 2009-2019 at medium-sized medical center. Five patients were treated by DLDC with a follow-up period of 12 months posttreatment. The diagnosis was based on joint aspirated fluid analysis criteria. During the follow-up period, no later sequel, including avascular necrosis, or infection recurrence were observed. The new minimal invasive treatment technique suggested in this study seems to be efficient and safe in treating septic hip arthritis in children without later sequela or the need for open arthrotomy, especially if performed early on. However, due to the small study sample, no generalization of the findings can be made as future studies with larger study samples are needed to validate the DLDC technique.

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“…While open arthrotomy remains the gold standard for treatment of adult and pediatric septic arthritis, arthroscopic lavage is an acceptable alternative in the appropriate patient and adequately-trained surgeon [3,4,10,11] . In general, hip arthroscopy is technically challenging but its ease has improved with more fellowship-trained surgeons learning the procedure earlier in their careers as well as improvements in surgical instruments and techniques [8,12] . It is frequently utilized for noninfectious pathologies such as femoral acetabular impingement, ligamentum teres tears, chondral lesions and/or labral tears [13] .…”

Section: Discussionmentioning

confidence: 99%

“…Before the emergence of MRI, children who met Kocher criteria underwent hip aspiration to assist in the diagnosis of septic hip prior to surgical intervention [4,12] . The current study does not refute the study by Gottschalk et al regarding the importance of MRI utilization in the work up of suspected septic hip arthritis [4] and notes that arthroscopy is not indicated when extracapsular pathologies are found on pre-operative MRI -we would suggest that they are in fact contra-indicated in this setting.…”

Section: Discussionmentioning

confidence: 99%

Management of septic arthritis of the pediatric hip

Hughes

Upasani

Pennock

et al. 2020

Theory Clin Pract Pediatr

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The purpose of this study was to compare outcomes and reoperation rate between open and arthroscopic treatment of a suspected isolated septic hip in the pediatric population. Methods Retrospective review was performed on two cohorts of pediatric patients who underwent surgical intervention for suspected isolated septic hip arthritis at a single institution. Patients were subdivided into two cohorts based on whether they underwent an open versus arthroscopic approach. Patients were excluded if they received an initial surgery from an outside institution, did not have an acute, active infection at presentation, defined as a hip aspiration leukocyte count <50,000 cells with <75% neutrophils, had extracaspular pathology or osteomyelitis, or had septic arthritis of a joint other than the hip. Results Fifty-six hips were included [Open group (n = 36); Arthroscopic group (n = 20)]. Six percent (2/36) of hips in the open group and 26% (5/19) of hips in the arthroscopy group had a positive tissue culture (p = 0.041). Eleven hips (31%) underwent postoperative immobilization in the open group compared to one hip (5%) in the arthroscopic group (p = 0.039). Conclusions In the setting of isolated arthritis, arthroscopy is a reasonable treatment modality with no observed additional risk compared to open arthrotomy. However, with concomitant osteomyelitis or soft tissue abscess, open arthrotomy should remain the mainstay approach to address all elements of the infection.

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Surgical treatment options for septic arthritis of the hip in children

Cited by 16 publications

References 24 publications

Aspiration or arthrotomy for paediatric septic arthritis of the shoulder and elbow: a systematic review

Aspiration or arthrotomy for paediatric septic arthritis of the shoulder and elbow: a systematic review

Preliminary results: continuous double luminal catheter drainage for the management of septic hip arthritis in children

Management of septic arthritis of the pediatric hip

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