TREATMENTOF SEPTIC ARTHRITIS OF THE HIP JOINT – IS SURGERY AVOIDABLE?

Abstract

Introduction: Septic arthritis of the hip joint in the pediatric age group is considered as an indication for surgical drainage of the joint. The commonly accepted treatment is arthrotomy of the hip joint, and continuous lavage and drainage. The child is treated with intravenous antibiotic therapy and is sometimes placed in a cast.

Because of repeated technical problems with the drains, the senior author developed a method of treatment by repeated aspirations of the hip joint under ultra-sound guidance. We report the results of the first group of these patients, followed up for at least 2 years.

Methods: Hip aspiration is performed when a child is suspected to have septic arthritis of the hip joint based on clinical, radiographic, ultrasonic and laboratory examinations. When hip effusion is found, aspiration is performed under ultrasound guidance, using topical anesthesia and strict sterile technique. If the aspirated fluid is visibly purulent, the joins is irrigated with sterile saline until clear fluid is aspirated. The patient is admitted to the hospital and intravenous antibiotic therapy is initiated. Repeated ultrasound examinations are performed daily, and the joint is decompressed and irrigated again. The procedure is continued until no effusion is demonstrated.

Results: Twenty-four patients were treated for septic arthritis of the hip joint at our institution between January 1st 1990 and December 31st 1998. The first 3 patients were operated and then aspirated when the drains were clogged during the first post operative day. Twenty-one patients were treated by repeated aspirations. Four of those patients were operated when the aspiration failed or when the clinical course did not improve, all of them during the first 4 years of the study. Seventeen patients were treated by repeated aspirations only. The mean number of aspirations was 4, and the children tolerated them well. No complications were seen on follow-up, and all patients went back to full activities. No cases of avascular necrosis of the femoral head were identified.

Discussion and Conclusions: Arthrotomy and drainage of hip joint is an emergency procedure for the treatment of septic arthritis of the hip joint. Possible complications of the procedure are dislocation of the hip joint, avascu-lar necrosis of the hip joint and technical problems with drains. We describe a reliable and safe procedure, that does not necessitate general anesthesia and surgery. The 4 patients who did have to undergo surgery represent a learning curve, and were all treated during the first four years. No complications or late sequelae were seen in our patients.