ARTHROSCOPIC TREATMENT OF HIP SEPTIC ARTRHRITIS IN CHILDREN

Abstract

Hip septic arthritis requires prompt surgical decompression. The aim of this study is to evaluate the advantages and effectiveness of hip arthroscopy in alternative to arthrotomy.

Since 1996, 6 children affected by hip septic arthritis were treated by arthroscopy. The mean follow up was 7.5 years (8–7 years), 2 patients were female and 4 male, the mean age was 6.5 years (from 4 to 8).

Time from onset of symptoms to operative treatment ranged from 24 h to 4 days. The surgical procedure was performed with the patient in the supine position and the leg in slight traction, by means of a sopratrocanteri c portal. A standard 4.5 mm arthroscope with a 70° optics was used. A sample or articular fluid was harvested for bacteriological and gram stain examination. The joint was then washed out with 8–10 litres of saline solution. No drain was left inside and all the patients were treated by a guided antibiotic therapy post-op.

In all cases a grossly purulent fluid was aspirated. In 3 cases the gram stain showed a S. Aureus as responsible of the infection. No complications were attributable to the arthroscopy in the intra and post-op period. ESR, PCR and WBC count normalized after 3 days post-op in all cases. The mean period of hospitalisation was 8 days (from 5 to 13), the mean time of full recovery was 17 days (from 15 to 20). At 7 years of follow-up no recurrence was reported and the clinical evaluation showed no pain and no functional restriction of the operated hip.

Early surgical drainage is the main treatment for septic arthritis of the hip. Hip arthroscopy allows to completely remove the purulent fluid from the inside of the hip joint, by means of a large volume lavage and direct suction. Hip arthroscopy demonstrated to be an excellent alternative to arthrotomy for treatment of septic arthritis in children old enough to be safely arthroscoped, with a significantly less morbidity.