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Darraj H, Hakami KM, Zogel B, Maghrabi R, Khired Z. Septic Arthritis of the Knee in Children. Cureus 2023; 15:e45659. [PMID: 37868524 PMCID: PMC10590147 DOI: 10.7759/cureus.45659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Septic arthritis of the knee is the most common form of septic arthritis in children and can lead to irreversible damage to the joint. Staphylococcus aureus is the primary pathogen associated with septic arthritis, although other causative pathogens may be isolate in children with specific risk factors. The diagnosis of knee septic arthritis is based on comprehensive evaluation, including the patient's medical history, physical examination, blood tests, and arthrocentesis. Empirical treatment typically involves anti-staphylococcal penicillin or a first-generation cephalosporin, although modifications may be made based on local resistance patterns and clinical culture data. Surgical debridement, either through open surgery or arthroscopy, involving extensive debridement of the joint, is effective in eliminating the infection. In most cases, additional surgical intervention is not necessary.
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Affiliation(s)
| | | | - Basem Zogel
- Medicine and Surgery, Jazan University, Jazan, SAU
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Barik S, Raj V, Prasad SG, Richa, Garg V, Singh V. Comparison of Various Joint Decompression Techniques in Septic Arthritis of the Hip in Children: A Systematic Review and Meta-Analysis. Hip Pelvis 2023; 35:73-87. [PMID: 37323550 PMCID: PMC10264229 DOI: 10.5371/hp.2023.35.2.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 11/22/2023] Open
Abstract
The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic arthritis of the hip in children. A search of literature in PubMed, Embase, and Google Scholar was conducted for identification of studies reporting on the outcomes of intervention for septic arthritis of the hip in children. Of the 17 articles selected, four were comparative studies; two of these were randomized controlled trials while the rest were single arm studies. Statistical difference was observed between the proportion of excellent clinical and radiological outcomes in arthrotomy (90%, 95% confidence interval [CI] 81-98%; 89%, 95% CI 80-98%), arthroscopy (95%, 95% CI 91-100%; 95%, 95% CI 90-99%), and arthrocentesis (98%, 95% CI 97-100%; 99%, 95% CI 97-100%), respectively. The highest overall rate of additional unplanned procedures was observed in the arthrocentesis group (24/207, 11.6%). Patients who underwent arthrocentesis had a statistically greater chance of excellent clinical and radiological outcomes, although the highest level of need for additional unplanned surgical intervention was observed in the arthrocentesis group, followed by the arthroscopy group and the arthrotomy group. Future conduct of a prospective multicentric study focusing on the developed and developing world, along with acquisition of data. such as delay of treatment and severity of disease will enable assessment of the efficacy of one technique over the other by surgeons worldwide.
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences Deoghar, Deoghar, India
| | - Vikash Raj
- Department of Orthopedics, All India Institute of Medical Sciences Deoghar, Deoghar, India
| | - Sant Guru Prasad
- Department of Orthopedics, All India Institute of Medical Sciences Deoghar, Deoghar, India
| | - Richa
- Department of Community and Family Medicine, All India Institute of Medical Sciences Deoghar, Deoghar, India
| | - Varun Garg
- Department of Orthopedics, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
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Rotem G, Zur-Aviran N, Sherr-Lurie N, Weltsch D, Schindler A, Tenenbaum S, Givon U. Treatment of Septic Arthritis of the Hip Joint Using Repeated Aspirations: When Should We Operate? Indian J Orthop 2022; 56:1090-1095. [PMID: 35669032 PMCID: PMC9123145 DOI: 10.1007/s43465-022-00616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The well-accepted treatment of septic arthritis of the hip joint (SAHJ) is surgical drainage of the joint, but repeated aspirations of the hip joint under sonography, have been used for over twenty years with significant success in some centers, including ours. In recent years, we identified some children who did not respond to aspirations and had to undergo arthrotomies. We were concerned that some children may have reached the operating room after a longer than ideal time. OBJECTIVE Identification of the characteristics of patients who did not respond to repeated aspirations and development of a treatment algorithm that expedites decision-making regarding the necessity of surgery. METHODS This is a single-center retrospective cohort analysis. All the patients diagnosed with SAHJ between 2007 and 2019 were identified. Patients who responded to repeated aspirations were compared to those who did not improve and required surgery. Demographic and clinical data and laboratory results were obtained from the patients' electronic medical records. RESULTS Forty-eight children (88.9%) were treated successfully with repeated aspirations and six children (11.1%) did not improve after aspirations and underwent hip arthrotomies. Five out of 48 children from the aspiration group (10.4%) and 4 out of 6 from the arthrotomy group (66.7%) had chronic comorbidities (p = 0.0051). The mean duration of fever over 38.5 degrees centigrade and the length of stay were higher in the arthrotomy group (p = 0.0040, p = 0.0301, respectively). When we examined the change in C-reactive protein (CRP) levels before and after the first aspiration (Delta CRP), we found a decrease in the aspiration group and an increase in the arthrotomy group (p = 0.0044). CONCLUSION The new algorithm which we present allows an expeditious assessment of the patient's response to the repeated aspiration method and thus prevents unnecessary surgeries for the treatment of SAHJ. Patients with chronic comorbidities, prolonged fever, and an increase in CRP level following the first aspiration, are at risk of treatment failure and should be treated with an arthrotomy. LEVEL OF EVIDENCE FOR CLINICAL ARTICLES Level 4-cohort study.
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Affiliation(s)
- Gilad Rotem
- Orthopedic Division, Hand Surgery Department, Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel-Hashomer, 5262100 Ramat Gan, Israel
| | - Noa Zur-Aviran
- Pediatric Orthopedics Unit, Sheba Medical Center, Affiliated to Sackler School of Medicine, Safra Hospital for Children, Ramat Gan, Israel
| | - Nir Sherr-Lurie
- Pediatric Orthopedics Unit, Sheba Medical Center, Affiliated to Sackler School of Medicine, Safra Hospital for Children, Ramat Gan, Israel
| | - Daniel Weltsch
- Pediatric Orthopedics Unit, Sheba Medical Center, Affiliated to Sackler School of Medicine, Safra Hospital for Children, Ramat Gan, Israel
| | - Amos Schindler
- Pediatric Orthopedics Unit, Sheba Medical Center, Affiliated to Sackler School of Medicine, Safra Hospital for Children, Ramat Gan, Israel
| | - Shay Tenenbaum
- Orthopedic Division, Sheba Medical Center, Affiliated to Sackler School of Medicine, Ramat Gan, Israel
| | - Uri Givon
- Pediatric Orthopedics Unit, Sheba Medical Center, Affiliated to Sackler School of Medicine, Safra Hospital for Children, Ramat Gan, Israel
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Di Pietro GM, Borzani IM, Aleo S, Bosis S, Marchisio P, Tagliabue C. Pediatric Septic Arthritis of the Knee Due to a Multi-Sensitive Streptococcus pyogenes Strain Responsive to Clindamycin-A Case Report. CHILDREN-BASEL 2021; 8:children8030189. [PMID: 33802408 PMCID: PMC8001213 DOI: 10.3390/children8030189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/24/2022]
Abstract
Septic arthritis is an inflammatory process usually generated by a bacterial infection. The knee is one of the most frequently involved joints. The etiology varies depending on age, and hematogenous spread remains the primary cause in children. Herein, we report a case of a previously healthy three-year-old female who was referred to our institution for acute swelling of her right knee. After a clinical and radiological diagnosis of septic arthritis, an empirical treatment with a combination of cefotaxime and clindamycin was initiated. The isolation of a multi-sensitive Streptococcus pyogenes strain from the joint’s effusion prompted the discontinuation of clindamycin and the usage of cefotaxime alone. One week later, an ultrasound was executed due to worsening in the patient’s clinical conditions, and an organized corpuscular intra-articular effusion with diffuse synovial thickening was revealed. Cefotaxime was therefore replaced with clindamycin, which improved the symptoms. Despite the antibiotic sensitivity test having revealed a microorganism with sensitivity to both cephalosporin and clindamycin, clinical resistance to cefotaxime was encountered and a shift in the antimicrobial treatment was necessary to ensure a full recovery. This case study confirms that an antibiotic regimen based solely on a susceptibility test may be ineffective for such cases.
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Affiliation(s)
- Giada Maria Di Pietro
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Correspondence:
| | - Irene Maria Borzani
- Radiology Unit, Pediatric Division, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Sebastiano Aleo
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
| | - Samantha Bosis
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Claudia Tagliabue
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
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Piper D, Smith G, Archer JE, Woffenden H, Bose D. Management of Native Joint Septic Arthritis, Serial Aspiration vs. Arthroscopic Washout During the COVID-19 Pandemic. Cureus 2020; 12:e11391. [PMID: 33194503 PMCID: PMC7654978 DOI: 10.7759/cureus.11391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/30/2022] Open
Abstract
Septic arthritis remains an orthopaedic emergency that requires prompt diagnosis and management. During the 2020 COVID-19 pandemic, British Orthopaedic Association (BOAST) guidelines dictated that medical treatment (closed-needle aspiration + antibiotic therapy) should be offered to patients as first-line management, and operative treatment (arthroscopic joint washout +/- synovectomy) be reserved for patients exhibiting signs of sepsis. Literature has previously shown that for native joint septic arthritis, operative treatment is not superior to medical treatment. During the COVID-19 'lock-down' period (March 2020 to June 2020), we prospectively followed the presentation, diagnosis, management and outcome of a total of six patients who presented with confirmed native joint septic arthritis. All six patients underwent initial medical management of their septic arthritis following their diagnostic aspiration, which involved serial closed-needle aspirations and antibiotic therapy as advised by our microbiology team. Four patients went on to have an arthroscopic washout at an average of eight days following admission (mean 2.5), prior to a consultant-led decision to proceed to arthroscopic washout. The decision for operative management was the patient's clinical deterioration based on physiological (fever, tachycardia) and biochemical (C-reactive protein (CRP), white blood cell (WBC)) parameters. All of the four patients that proceeded to operative treatment failed to provide culture yield at the time of arthroscopic washout. The mean time to discharge was 15.6 days, whilst the mean time to discharge following operative intervention was 12 days. One patient passed away during admission and one patient required a second arthroscopic washout. Medical management of septic arthritis may play a role in symptom control in the palliative setting or in patients where a general anaesthetic is undesirable. We found operative management to be therapeutic clinically, haemodynamically and biochemically as well as facilitative of a faster recovery and shorter inpatient stay.
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Affiliation(s)
- Danielle Piper
- Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, GBR
| | - Gemma Smith
- Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, GBR
| | - James E Archer
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, GBR
| | - Hugo Woffenden
- Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, GBR
| | - Deepa Bose
- Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, GBR
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Pääkkönen M. Septic arthritis in children: diagnosis and treatment. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:65-68. [PMID: 29388627 PMCID: PMC5774603 DOI: 10.2147/phmt.s115429] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Acute septic arthritis in children is usually hematogenous. It is more common in boys, and it most often affects the large joints of the lower limb. Diagnosis is based on cultures obtained from the infected joint and is supported by C-reactive protein blood test or ultrasound imaging. Staphylococcus aureus is the most common causative agent and is the primary target for empiric treatment. First-generation cephalosporins and clindamycin are suitable antibiotics. Vancomycin is utilized in areas with high rates of clindamycin- and methicillin-resistant S. aureus. After a short intravenous administration of 2–4 days, a total course of 2 weeks is sufficient in uncomplicated cases. Early antibiotic treatment has significantly improved the prognosis in high-income settings, but uncomplicated recovery is compromised if the treatment is delayed. Complications such as symptomatic osteoarthritis or avascular necrosis of the femoral head develop slowly. A long follow-up of 1–2 years is required to detect all possible sequelae.
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Affiliation(s)
- Markus Pääkkönen
- Department of Pediatric Orthopaedic Surgery.,Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
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Agarwal A, Aggarwal AN. Bone and Joint Infections in Children: Septic Arthritis. Indian J Pediatr 2016; 83:825-33. [PMID: 26189923 DOI: 10.1007/s12098-015-1816-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. The knee and hip are the most frequently involved joints. Staphylococcus aureus is the most common cause of septic arthritis in children. An acute onset of illness with an inflamed painful joint and restricted movements and inability to use joint (pseudoparalysis) clinically indicates septic arthritis. The diagnosis is difficult in a neonate or young child where refusal to feed, crying, discomfort during change of diaper (if hip is involved) or attempted joint movement may be the only findings. Fever and other systemic signs may also be absent in neonates. Septic arthritis is diagnosed clinically, supported by appropriate radiological and laboratory investigations. The peripheral blood white cell count is frequently raised with a predominance of polymorphonuclear cells. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often markedly raised. Ultrasonography and MRI are preferred investigations in pediatric septic arthritis. Determination of infecting organism in septic arthritis is the key to the correct antibiotic choice, treatment duration and overall management. Joint aspirate and/or blood culture should be obtained before starting antibiotic treatment. Several effective antibiotic regimes are available for managing septic arthritis in children. Presence of large collections, thick pus, joint loculations and pus evacuating into surrounding soft tissues are main indications for surgical drainage. Joint aspiration can be a practical alternative in case the lesion is diagnosed early, with uncomplicated presentations and superficial joints.
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Affiliation(s)
- Anil Agarwal
- Department of Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India.
| | - Aditya N Aggarwal
- Department of Orthopedics, UCMS and GTB Hospital, Shahdara, Delhi, India
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Abstract
Septic arthritis is the result of bacterial infection of the hip joint and is often found in infants and toddlers. It is the most common septic joint condition during growth and may cause the most devastating complications without prompt and proper treatment. Early diagnosis and intervention are required to avoid irreversible complications. This review documents the systematic approach to diagnosis and management of septic arthritis in children.
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Affiliation(s)
- Gang Xu
- Department of Pediatric Orthopedic, Beijing Jishuitan Hospital, 100035 Beijing, China; Department of Pediatric Orthopedic, University Children's Hospital, UKBB, CH-4031 Basel, Switzerland,
| | - Muriel Spoerri
- Department of Pediatric Orthopedic, University Children's Hospital, UKBB, CH-4031 Basel, Switzerland
| | - Erich Rutz
- Department of Pediatric Orthopedic, University Children's Hospital, UKBB, CH-4031 Basel, Switzerland
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Blankstein A. Ultrasound in the diagnosis of clinical orthopedics: The orthopedic stethoscope. World J Orthop 2011; 2:13-24. [PMID: 22474631 PMCID: PMC3302037 DOI: 10.5312/wjo.v2.i2.13] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/11/2011] [Accepted: 02/15/2011] [Indexed: 02/06/2023] Open
Abstract
Ultrasonography has advantages over other imaging modalities in terms of availability and comfort, safety, and diagnostic potential. Operating costs are low compared with both computed tomography (CT) and magnetic resonance imaging (MRI). The portable equipment is accessible at locations distant from medical centers. Importantly, ultrasonography is performed while patients lie in a comfortable position, without pain or claustrophobia. Ultrasonography is a totally safe noninvasive imaging technique. In contrast to CT and X-rays, it does not emit ionizing radiation. Unlike MRI, it is safe for all patients, including those with cardiac pacemakers and metal implants, without any contraindications. Of the many indications for musculoskeletal ultrasonography, the evaluation of soft tissue pathology is particularly common. In addition, ultrasonography is useful for the detection of fluid collection, and for visualization of cartilage and bone surfaces. Color or power Doppler provides important physiological information, including that relating to the vascular system. The capability of ultrasonography in delineating structures according to their echotextures results in excellent pictorial representation. This imaging principle is based on physical changes in composition, as compared to imaging with MRI, which is based on changes in chemical composition. This article reviews the contribution of sonography to the evaluation of the musculoskeletal system.
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Abstract
Hip pain is a common paediatric presentation and is potentially serious. While hip pain can be attributed to primary hip pathology, the hip area is also a common site for referred pain. This often poses a diagnostic challenge particularly in the young child who may not verbalise the point of pain and may not report an injury. Differential diagnoses for paediatric hip joint pain range from fracture, transient synovitis, septic arthritis with or without osteomyelitis, juvenile idiopathic arthritis (JIA, previously juvenile rheumatoid arthritis JRA), Legg-Calve-Perthes' disease (LCP), slipped capital femoral epiphysis (SCFE) to haemarthrosis in patient with a clotting disorder. Referred pain from abdominal pathology, for example; appendicitis, psoas abscess or haematoma should also be considered. The evaluation and management of hip pain requires a thorough history and physical examination. A radiograph is usually indicated to rule out any bony injury. Septic arthritis is a medical emergency requiring urgent surgical as well as medical treatment. Ultrasound of the hip joint plays a role in helping to differentiate which hips require early intervention and to guide a needle aspiration of joint fluid if indicated. In this article, we aim to review the anatomy of the hip, techniques in ultrasonographic examination and some common pathologies in the paediatric hip.
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Affiliation(s)
- A Crow
- Department of Medical Imaging The Children's Hospital at Westmead Westmead New South Wales 2145 Australia
| | - A Cheung
- Hunter New England Imaging Service John Hunter Hospital Newcastle New South Wales 2300 Australia
| | - A Lam
- Department of Medical Imaging The Children's Hospital at Westmead Westmead New South Wales 2145 Australia
| | - E Ho
- Department of Paediatric Orthopaedics John Hunter Hospital Newcastle New South Wales 2300 Australia
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Givon U, Ganel A. Re: Treatment of early septic arthritis of the hip in children: comparison of results of open arthrotomy versus arthroscopic drainage. J Child Orthop 2008; 2:499. [PMID: 19308549 PMCID: PMC2656862 DOI: 10.1007/s11832-008-0138-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Accepted: 09/16/2008] [Indexed: 02/03/2023] Open
Affiliation(s)
- Uri Givon
- Pediatric Orthopedics Unit, Safra Hospital for Children, Sheba Medical Center, 52621 Tel HaShomer, Israel
| | - Abraham Ganel
- Pediatric Orthopedics Unit, Safra Hospital for Children, Sheba Medical Center, 52621 Tel HaShomer, Israel
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Treatment of early septic arthritis of the hip in children: comparison of results of open arthrotomy versus arthroscopic drainage. J Child Orthop 2008; 2:229-37. [PMID: 19308583 PMCID: PMC2656801 DOI: 10.1007/s11832-008-0094-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 02/15/2008] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The goal of this study was to compare results of open arthrotomy versus arthroscopic drainage in treating septic arthritis of the hip in children. METHODS This prospective controlled study was conducted on twenty patients (20 hips) with acute septic arthritis of the hip. Diagnosis was suspected if there was: a history of fever, non-weight-bearing on the affected limb, erythrocyte sedimentation rate (ESR) of at least 40 mm/h, and white blood cell count of more than 12,000 cells per cubic millimeter. Diagnosis was established by ultrasonographic examination of the affected hip followed by ultrasound-guided aspiration of the joint. Patients were allocated to have either open arthrotomy or arthroscopic drainage of the joint. There were ten patients (ten hips) in each treatment group. The mean age of the patients was 7.3 years in the arthrotomy group, and 8 years in the arthroscopy group. The mean temperatures for the arthrotomy and arthroscopy groups were 38.8 and 38.7 degrees C, respectively. All the children were unable to bear weight on the affected limb. RESULTS Staphylococcus aureus was the most common causative microorganism in both groups. The mean duration of the children's hospital stay was 6.4 days in the arthrotomy group and 3.8 days in the arthroscopy group. The difference was highly significant. Infection could be eradicated in all patients of both groups. At the latest follow-up, seven children in the arthrotomy group (70%) had excellent results and three children (30%) had good results. In the arthroscopy group, nine children (90%) had excellent results and one child (10%) had good results. The difference was not statistically significant. CONCLUSIONS Arthroscopic drainage is an effective method in treating septic arthritis of the hip. It is a minimal invasive procedure which is associated with less hospital stay. Arthroscopic drainage of septic arthritis of the hip in children is a valid alternative procedure in early uncomplicated cases and for orthopedic surgeons skilled in pediatric arthroscopy.
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