Re: Treatment of early septic arthritis of the hip in children: Comparison of results of open arthrotomy versus arthroscopic drainage

Abstract

We have read Dr. El-Sayed's paper with interest and would like to congratulate him on his well-performed study [1]. The comparison of the two surgical techniques proves that the treatment principle is pus evacuation in any possible technique. We have previously published a paper on the use of repeated ultrasound-guided hip aspirations to treat septic arthritis of the hip [2]. The hips were aspirated and lavaged daily in the ultrasound suite without the need for surgical intervention and without complications. Our good medium-term results demonstrated that repeated aspirations can be used with very good outcomes and safety.The author has mentioned our paper in the context of preoperative diagnostic hip aspiration, but did not quote it in his discussion as an alternative technique for the treatment of hip septic arthritis. We believe that repeated hip aspirations are the best treatment option for the child with septic arthritis of the hip, and that surgical intervention, either arthrotomy or arthroscopy, should be reserved only for the rare patient who does not respond to treatment after 2-3 aspirations. We are happy to say that we have performed only four arthrotomies in the last 12 years, and that our technique has become the usual practice in several pediatric orthopedic departments in Israel.

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

“…Finally, in regard to the location of the infection, exclusively oral treatment in patients with hip involvement should be individualized according to the specialist's criteria since in the literature this location has been related to the appearance of sequelae, especially when the damage occurs in the neonatal period. [39][40][41][42] Also, we strongly recommend the conventional management and close hospital monitoring of patients with cervical SD due to the possible association with local soft tissue abscess that could compromise the airway or the neurologic damage that it could cause. [43][44] A number of limitations in our study need to be considered, such as the small size of group 2 or the microbiology not yielding a microorganism in 68.7% of the cases.…”

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

“…Typically, CRP values are lower in younger children, as well as in infections produced by K. kingae (13,(35)(36)(37) and are higher in IOA caused by S. aureus (37)(38). Different cut-off values of CRP have been proposed by different authors to optimize the approach of patients with OAI, ranging 80-170 mg / L. (22,(37)(38)(39). Although no CRP cut-off point with su cient sensitivity and speci city could be de ned in the study.…”

SEIP–SERPE–SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis

“…17 Therapeutic arthrocentesis can be used for any joint, including the shoulder and the hip, as various studies show. 1,4,5,17---20 In a randomised study of children with arthritis of the shoulder, for example, no differences were found in prognosis or length of stay in patients treated with aspiration versus arthrotomy.…”

“…4,19 Equally, other authors recommend surgical intervention if the joint fluid is not satisfactorily drained after 2 or 3 arthrocenteses. 17 Arthrotomy could be indicated, at the outset, in cases of longer evolution, given the greater difficulty of evacuating denser and more organised material, 13,16 in cases of raised inflammatory markers or of highly virulent pathogens (MRSA) and in neonates and small infants. 5,19 The object of the surgical procedure can be regarded as threefold 21 : drainage of the purulent content and necrotic material, reduction of the intra-articular pressure and direct assessment of the lesion, and also a collection of microbiological and anatomopathological samples.…”