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Orthop Traumatol Surg Res. 2011 May;97(3):308-13. doi: 10.1016/j.otsr.2011.01.009. Epub 2011 Apr 1.

Hip septic arthritis in children: assessment of treatment using needle aspiration/irrigation.

Author information

1
Department of Pediatric Orthopaedic Surgery, Nancy Teaching Hospital Center, Children Hospital, 5, allée du Morvan, 54511 Vandœuvre, France. p.journeau@chu-nancy.fr

Abstract

INTRODUCTION:

This retrospective series evaluated the surgical treatment of hip arthritis in children by needle aspiration-irrigation alone.

PATIENTS AND METHODS:

Forty-three cases of septic hip arthritis were treated by needle aspiration-irrigation under general anesthesia associated with intravenous then oral administration of antibiotics. Clinical and biological criteria at admission, during hospitalization and at final follow-up were studied to identify any criteria carrying a predictive value for unsuccessful needle aspiration-irrigation.

RESULTS:

Thirty-eight hips had a favorable outcome in this series, while secondary open arthrotomy was required in five hips for further irrigation. Common criteria found in the group requiring open arthrotomy were a diagnosis delay of at least 6 days between initial clinical symptoms and treatment as well as markedly abnormal biological results at admission. A threshold for the predictive value of certain variables was identified including C-reactive protein above 100, white polynuclear blood count above 15000, and sedimentation rate above 25 in the first hour and 50 in the second hour.

DISCUSSION:

Treatment modalities for septic arthritis of the hip remain controversial in children and various techniques have been shown to be effective in the literature. Needle aspiration-drainage, the least invasive of these, has been shown to have good results, even in the hip, even though this is a deep, tight, joint which is known to be difficult to drain. Prognostic criteria are difficult to identify, however all authors agree that delayed treatment makes evacuation of intra-articular debris especially difficult.

CONCLUSION:

Needle aspiration-irrigation is effective in septic arthritis of the hip, as long as basic principles are followed. Delayed treatment and certain biological criteria should be taken into account when selecting a treatment, since negative predictive criteria identified in this series were present in the five hips requiring secondary arthrotomy.

PMID:
21459064
DOI:
10.1016/j.otsr.2011.01.009
[Indexed for MEDLINE]
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