Minimally Invasive Irrigation of Neonatal Septic Arthritis Using 18-Gauge Needle Portals

Abstract

Septic arthritis in neonates requires prompt management to prevent joint destruction, long-term disability, and rapid sepsis progression. Traditional open surgical drainage can pose risks in neonates with small joint spaces. We describe a technique using two 18-gauge needles as irrigation and drainage portals for the minimally invasive treatment of neonatal septic arthritis of the hip. Under sterile conditions and radiographic guidance, two 18-gauge needles can be inserted percutaneously into the affected hip joint. Arthrogram dye is used to confirm joint placement. Saline is then instilled through one needle while effluent is drained through the other, achieving joint washout without open arthrotomy, which is confirmed by flushing out the arthrogram dye. This technique provides a safe, effective, and less invasive alternative for joint irrigation in neonates, especially where standard arthroscopic or open approaches carry higher morbidity.

Key concepts: (1)The diagnosis of neonatal septic arthritis can be challenging due to the lack of clinical signs or elevated laboratory findings and as a result of an immature immune system.(2)When septic arthritis is clinically suspected in this population, joint irrigation and possible debridement are often considered.(3)Open and arthroscopic methods used in children may be challenging in neonates, and joint irrigation through needles provides an option in selected cases.

Keywords: Arthrocentesis and joint lavage; Neonatal septic arthritis.

Figure 1

Intraoperative confirmation of an 18G needle in right hip joint with arthrogram dye injected. 18G, 18-gauge.

Figure 2

Intraoperative confirmation of the second 18G needle in the right hip joint with arthrogram dye still present before irrigating with saline. 18G, 18-gauge.

Figure 3

Intraoperative confirmation of arthrogram dye removal following irrigation with saline.