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Arthroscopic Treatment of Septic Arthritis in Very Young Children
Rachel M Thompson1, Prasad Gourineni
1*Department of Orthopaedic Surgery, Northwestern University, Chicago †Pediatric Orthopaedics, Advocate Hope & Christ Hospitals, Oak Lawn, IL.
Insights
Arthroscopic lavage is a safe and effective treatment for septic arthritis (SA) in very young children, offering improved visualization and irrigation with minimal complications. This minimally invasive approach is feasible across various joints, even in infants.
Area of Science:
- Pediatric Orthopedics
- Minimally Invasive Surgery
- Infectious Diseases
Background:
- Septic arthritis (SA) treatment in children often relies on open procedures.
- Arthroscopic lavage, common in adults, is less studied in pediatric SA.
- Previous pediatric studies were limited to case reports or older children.
Purpose of the Study:
- To evaluate the safety and efficacy of arthroscopic lavage for treating septic arthritis in very young children.
- To assess the feasibility of arthroscopic treatment across different pediatric joints.
Main Methods:
- A case series of 24 children (3 weeks to 6 years) treated with arthroscopic lavage for SA between 2011 and 2015.
- Utilized a single portal for inflow/outflow, with a second portal for knees and indicated synovectomies.
- Drains were placed for 2-3 days; antibiotic management was overseen by infectious disease specialists.
Main Results:
- The study included 9 hips, 9 knees, 4 ankles, and 2 shoulders.
- Arthroscopic portal placement, visualization, and lavage were straightforward.
- One transient femoral nerve palsy occurred; no other major complications or iatrogenic damage were noted.
- Two patients required repeat lavage, and one underwent subsequent open irrigation (average 1.125 procedures/subject).
- At a mean follow-up of 16 months, no infection recurrence or decreased range of motion was observed.
Conclusions:
- Arthroscopic lavage is a safe, quick, and effective alternative to open arthrotomy for pediatric septic arthritis.
- The technique is feasible in large joints of infants, offering superior visualization and irrigation with reduced morbidity.
- The study supports the regular use of arthroscopic treatment for SA in young children.
Introduction:
Arthroscopic lavage is a well-established, minimally invasive treatment for septic arthritis (SA) in adults, but the use of arthroscopy in the pediatric population is typically restricted to sports injuries and deformity. Previous research on arthroscopic lavage of septic joints in the pediatric population has been limited to case reports and small case series of older children. As such, we aimed to evaluate the safety and efficacy of arthroscopic treatment of SA in various joints in very young children.
Methods:
Between 2011 and 2015, 24 children (aged 3 wk to 6 y) were treated for SA with arthroscopic lavage. A single portal was adequate for both inflow and outflow in most cases. A second portal was used in all knees and in other joints for synovectomy, when indicated. Drains were placed through the portal site and remained in place for 2 to 3 days. Antibiotics were managed by the infectious disease service.
Results:
Nine hips, 9 knees, 4 ankles, and 2 shoulders were included. Portal placement, visualization, and adequate lavage were straight forward in all joints. There was 1 transient femoral nerve palsy and no other arthroscopy-associated complications (iatrogenic damage, difficult drain placement, or conversion to open). Two patients required repeat arthroscopic lavage for disease eradication, one of which required a second admission. A third patient underwent open irrigation following arthroscopic lavage with a resultant 1.125 average procedures per subject. At final follow-up (2 to 49 mo, average 16 mo), no recurrence of infection or decreased range of motion was noted.
Conclusions:
Arthroscopic lavage appears to be a safe, quick, and effective alternative to open arthrotomy for the treatment of SA in very young children. It is feasible in any large joint even in the infantile population, allowing for improved visualization and irrigation with little soft-tissue dissection and morbidity. Our relatively simple technique and positive results should encourage regular use of arthroscopic treatment of SA even in very young children.
Level Of Evidence:
Level IV-case series.
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Etiology
Three primary contributing factors have been identified.