Septic Hip Arthritis in Children: A Comparison of Arthrocentesis and the Double Luminal Drainage Catheter

Abstract

Background: Septic hip arthritis in children is an orthopaedic emergency. While the well-established surgical treatment is open arthrotomy, several minimally invasive techniques have been offered as alternatives in recent years. The purpose of this study was to compare the clinical outcome of a continuous double luminal drainage catheter (DLDC) with repeated arthrocentesis, in the treatment of septic hip arthritis in children. Methods: Medical records were retrospectively reviewed for all patients aged 1 to 18 years diagnosed with septic hip arthritis between 2005 and 2020 and treated with either DLDC or arthrocentesis. The clinical outcomes of 17 patients who fulfilled the inclusion criteria were compared. 8 were treated using DLDC, and 9 were treated by arthrocentesis. All patients had a follow-up period of 12 months after treatment. Results: In the DLDC group, the catheter was inserted continuously, with a median of 4 days. A single aspiration sufficed in 8 of 9 patients. The duration of hospitalization was significantly longer (P = 0.004) in the DLDC group (mean 21.6 SD 10.04 days), compared with the arthrocentesis group (mean 9.2 SD 1.7 days). The median time until patients returned to normal gait was 12 days (range 4 to 110) in the DLDC group, compared with 8 days (range 7 to 14) in the arthrocentesis group. None of the patients required open arthrotomy, and no infection recurrence was observed. Discussion: In conclusion, while both suggested minimally invasive techniques may be safe and efficient in the treatment of septic hip arthritis in children, arthrocentesis is associated with a shorter duration of hospitalization. However, continuous drainage with a DLDC may be a better modality for severe cases. Additional research is needed to determine specific indications, considering the widely accepted benchmark of open arthrotomy. Level of Evidence: III