Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 4;56(6):1090-1095.
doi: 10.1007/s43465-022-00616-5. eCollection 2022 Jun.

Treatment of Septic Arthritis of the Hip Joint Using Repeated Aspirations: When Should We Operate?

Gilad Rotem #  1 , Noa Zur-Aviran #  2 , Nir Sherr-Lurie  2 , Daniel Weltsch  2 , Amos Schindler  2 , Shay Tenenbaum  3 , Uri Givon  2
Affiliations

Treatment of Septic Arthritis of the Hip Joint Using Repeated Aspirations: When Should We Operate?

Gilad Rotem et al. Indian J Orthop. .

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.

Keywords: Hip arthrotomy; Hip aspiration; Risk factors; Septic arthritis; Treatment algorithm; Ultrasonography guided.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestThe authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Treatment protocol flowchart
See this image and copyright information in PMC

References

    1. Bennett OM, Namnyak SS. Acute septic arthritis of the hip joint in infancy and childhood. Clinical Orthopaedics and Related Research. 1992 doi: 10.1097/00003086-199208000-00021. - DOI - PubMed
    1. Herndon WA, Knauer S, Sullivan Andy J, Gross RH. Management of septic arthritis in children. Journal of Pediatric Orthopedics. 1986;6:576–578. doi: 10.1097/01241398-198609000-00009. - DOI - PubMed
    1. Montgomery NI, Epps HR. Pediatric Septic Arthritis. Orthopedic Clinics of North America. 2017;48:209–216. doi: 10.1016/j.ocl.2016.12.008. - DOI - PubMed
    1. Shukla A, Beniwal SK, Sinha S. Outcome of arthroscopic drainage and debridement with continuous suction irrigation technique in acute septic arthritis. Journal of Clinical Orthopaedics and Trauma. 2014;5:1–5. doi: 10.1016/j.jcot.2014.01.004. - DOI - PMC - PubMed
    1. De Sa D, Cargnelli S, Catapano M, et al. Efficacy of hip arthroscopy for the management of septic arthritis: A systematic review. Arthroscopy Journal of Arthroscopy Related Surgery. 2015;31:1358–1370. doi: 10.1016/j.arthro.2014.12.028. - DOI - PubMed

LinkOut - more resources