Arthroscopic Treatment of Acute Septic Arthritis of the Hip Joint in Pediatric Patients Aged 10 Years or Younger

PURPOSE:

To present the results of arthroscopic treatment of acute septic arthritis of the hip joint in children aged 10 years or younger.

METHODS:

Patients with a minimum follow-up period of 2 years who underwent arthroscopic treatment (anterolateral and medial subadductor 2-portal approach) of acute septic arthritis of the hip joint between January 2014 and January 2017 were included in this retrospective case-series study. The exclusion criteria included fungal infection, late presentation (≥5 days after the onset of the symptoms), presence of concomitant osteomyelitis, osseous pathologic conditions on radiography suggesting osteomyelitis, immunocompromised condition, history of surgery or infection surgery from the affected extremity, immobility owing to neuromuscular pathologic conditions, and identification of inflammatory or reactive arthritis during follow-up. The diagnosis of septic arthritis was confirmed according to the Waldvogel criteria. Clinical outcomes were assessed according to the Bennett score and Harris Hip Score.

RESULTS:

We evaluated 15 hips in 15 patients (6 female and 9 male patients) with a mean age of 5.2 years (range, 2-10 years) in this study. The mean hospital stay was 4.2 days (range, 3-7 days), and the mean antibiotic-use period was 34 days (range, 26-45 days). The most causative pathogen was Staphylococcus aureus (40%) (including methicillin-sensitive S aureus) and was isolated and cultured in all patients. All patients had full range of motion of the hip joint. All of the Bennett scores were excellent; the mean Harris Hip Score was 96.3 (range, 92.5-100) after a minimum follow-up period of 24 months (mean, 26.1 ± 3.2 months; range, 24-35 months). No patient needed additional surgical intervention. No degenerative changes or avascular necrosis developed.

CONCLUSIONS:

According to our results, arthroscopic treatment is an effective choice for the treatment of acute septic arthritis of the hip joint in children aged 10 years or younger.

LEVEL OF EVIDENCE:

Level IV, retrospective case series.

 2019 Nov 13. pii: S0749-8063(19)30751-0. doi: 10.1016/j.arthro.2019.08.031. [Epub ahead of print]