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

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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.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Gilad Rotem and Noa Zur-Aviran made an equal contribution to the manuscript.

Authors and Affiliations

  1. Orthopedic Division, Hand Surgery Department, Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel-Hashomer, 5262100, Ramat Gan, Israel

    Gilad Rotem

  2. Pediatric Orthopedics Unit, Sheba Medical Center, Affiliated to Sackler School of Medicine, Safra Hospital for Children, Ramat Gan, Israel

    Noa Zur-Aviran, Nir Sherr-Lurie, Daniel Weltsch, Amos Schindler & Uri Givon

  3. Orthopedic Division, Sheba Medical Center, Affiliated to Sackler School of Medicine, Ramat Gan, Israel

    Shay Tenenbaum

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  1. Gilad Rotem
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Contributions

Dr. GR MD and Dr. NZ-A MD contributed to data acquisition and analysis, drafted and edited the manuscript. Dr. ST MD, Dr. AS MD, Dr. NS-L MD and Dr. DW MD interpreted the results and edited the manuscript. Dr. UG MD, conceptualized and designed the study, contributed to data analysis, interpreted the results and edited the manuscript. All authors were actively involved in the drafting and critical revision of the manuscript, and each approved the final version that is submitted

Corresponding author

Correspondence to Gilad Rotem.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This article does not contain any studies animals performed by any of the authors. This study contains patient data and was approved by the institutional research committee and conducted in accordance with the 1964 Helsinki declaration and its later amendments. Approval reference number: 3441-16-SMC.

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For this type of study, informed consent is not required.

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Rotem, G., Zur-Aviran, N., Sherr-Lurie, N. et al. Treatment of Septic Arthritis of the Hip Joint Using Repeated Aspirations: When Should We Operate?. JOIO 56, 1090–1095 (2022). https://doi.org/10.1007/s43465-022-00616-5

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  • DOI: https://doi.org/10.1007/s43465-022-00616-5

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