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Surgical treatment of septic arthritis of the hip in children: arthrotomy compared with repeated aspiration-lavage

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Abstract

Purpose

To review two cohorts of children treated by two different protocols (repeated needle aspiration-lavage vs. arthrotomy) for surgical treatment of septic arthritis of the hip (SAH).

Methods

In order to compare between the two methods, the following parameters were checked: (a) Scar cosmesis was assessed by the Patient and Observer Scar Assessment Scale (POSAS). We considered satisfactory results (no scar discomfort) when POSAS was within 10% of the ideal score; (b) 24-h post-operative pain was evaluated by visual analog scale (VAS); (c) Complication rates of incomplete drainage (re-arthrotomy/therapy modification from aspiration-lavage to arthrotomy). The results were evaluated by the Student t-test or by the chi-square test.

Results

Seventy-nine children (aged 2–14 years) admitted during 2009–2018 and available for at least two years of follow-up were enrolled. The POSAS score (range 12–120 points) at the latest follow-up was higher in the arthrotomy group compared with the aspiration-lavage group (18.10 ± 6.22 versus 12.27 ± 1.40, p < 0.001); 77.4% of patients treated by arthrotomy had no scar discomfort. The 24-h post-intervention VAS (range 1–10) was 5.06 ± 1.29 after arthrotomy and 4.03 ± 1.13 after aspiration-lavage, p < 0.04. Complications were three times more frequent in the aspiration-lavage group (8.8% in the arthrotomy group and 26.7% in the aspiration-lavage group, p = 0.045).

Conclusions

We conclude that the lower complication rate observed in the arthrotomy group outweighs by far scar cosmesis and post-operative pain advantages in the aspiration-lavage group. Arthrotomy as a drainage method is safer than aspiration-lavage.

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Data availability

Data used for statistical analysis is available on request from the corresponding author.

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Acknowledgements

The study was presented in a concise form as an E-poster, at the German Congress of Orthopaedics and Traumatology, Berlin 2021.

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Authors and Affiliations

  1. Department of Orthopaedics, Soroka Medical Center, POB 151, 84101, Beer Sheva, Israel

    Eugen Cohen, Yuri Klassov & Alexander Gefler

  2. Ben Gurion University, Beer Sheva, Israel

    Eugen Cohen, Yuri Klassov, Bar Mazilis, Alexander Gefler & Eugene Leibovitz

  3. Division of Pediatrics, Soroka Medical Center, Beer Sheva, Israel

    Ron Leibovitz & Eugene Leibovitz

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  1. Eugen Cohen
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Contributions

All authors whose names appear on the submission made substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of the data. All the authors approved the version to be published.

EC: study design, methodology, data acquisition, data analysis, and writing of the manuscript

YK: data acquisition, data analysis, and methodology

RL: data extraction, data analysis, and statistics

BM: data extraction, data analysis, and draft of the work

AG: literature review and critical revision of the manuscript

EL: methodology, data analysis, and writing of the manuscript—review and editing

Corresponding author

Correspondence to Eugen Cohen.

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Ethical approval

Approval from the institutional review board (IRB) of the Soroka Medical Center, Ben Gurion University, Beer Sheva, was obtained prior to the initiation of the study.

Consent to participate

Written informed consent was obtained from the parents.

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The manuscript does not contain any individual person’s data. Consent to publish was not required.

Competing interests

The authors declare no competing interests.

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Level of evidence: III, retrospective, comparative study

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Cohen, E., Klassov, Y., Leibovitz, R. et al. Surgical treatment of septic arthritis of the hip in children: arthrotomy compared with repeated aspiration-lavage. International Orthopaedics (SICOT) 47, 1609–1618 (2023). https://doi.org/10.1007/s00264-023-05751-8

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