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Knee Arthritis in Children: When Can It Be Safely Treated With Needle Joint Aspiration? A Large Children's Tertiary
Eduard Tornero1,2, Josep Maria De Bergua-Domingo1, Pedro Domenech1
1Department of Paediatric Orthopaedic Surgery, Maternal and Child Hospital, Sant Joan de Déu of Barcelona.
Insights
Needle joint aspiration is a safe and effective treatment for septic knee arthritis in children under one year old. For children over three years old or those with high CRP levels, alternative treatments like arthroscopic debridement should be considered.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Pediatric Emergency Medicine
Background:
- Early joint decompression and antibiotic therapy are crucial for minimizing joint damage in pediatric septic knee arthritis.
- Various joint decompression techniques exist, including arthrotomy, arthroscopic drainage, and needle joint aspiration.
- This study aimed to identify pediatric patients with acute septic knee arthritis suitable for needle joint aspiration.
Purpose of the Study:
- To determine the safety and efficacy of needle joint aspiration for treating acute septic knee arthritis in children.
- To identify predictors of treatment failure for needle joint aspiration in this population.
Main Methods:
- A retrospective review of pediatric patients diagnosed with acute septic knee arthritis between September 2003 and December 2013.
- All patients initially received treatment with needle joint aspiration.
- The primary endpoint was the failure of joint aspiration as a treatment modality.
Main Results:
- Out of 74 patients, 11 (14.9%) experienced treatment failure, with a median age of 1.49 years.
- Age over 3 years was the only independent predictor of joint aspiration failure (OR, 5.64; P=0.018).
- Treatment success was observed in all patients under 1 year and in those under 3 years with C-reactive protein (CRP) levels <20 mg/L.
Conclusions:
- Needle joint aspiration is successful for septic knee arthritis in children under 1 year and those aged 1-3 years with CRP <20 mg/L.
- Arthroscopic debridement should be considered for children over 3 years old.
- Alternative treatments are recommended for children aged 1-3 years with CRP >20 mg/L.
Background:
Early joint decompression associated to antibiotic therapy is the most important procedure to reduce joint damage in septic knee arthritis in children. Several joint decompression methods have been described such as arthrotomy with open debriding, arthroscopic drainage or needle joint aspiration. The aim of the present study was to determinate which patients with acute septic knee arthritis could be safely treated with needle joint aspiration.
Methods:
Patients with an acute knee arthritis diagnosed between September 2003 and December 2013 in our children's tertiary hospital were retrospective review. All cases were initially treated with needle joint aspiration. Primary end-point was failure of joint aspiration.
Results:
A total of 74 patients were included in the study. Forty-two (56.8%) were male and median age was 1.49 years. Mean delay between onset of symptoms and diagnosis was 3.6 days and in 25 (33.8%) cases patients needed more than 1 visit to the emergency room. Median C-reactive protein (CRP) value was 36.3 mg/L and was >20 mg/L in 59 (79.7%) cases. A total of 11 (14.9%) patients showed failure of the joint aspiration treatment between 3 and 21 days after initial joint aspiration. The stepwise forward logistic regression model only identified as independent predictor of joint aspiration failure an age older than 3 years old (odds ratio, 5.64; 95% confidence interval, 1.38-29.61; P=0.018). Joint aspiration did not fail in any patient younger than 12 months and neither in any patient younger than 3 years old with CRP value <20 mg/L. Otherwise, treatment failed in 38% of patients older than 3 years and in 16% of patients between 1 and 3 years with a CRP>20 mg/L.
Conclusions:
Septic knee arthritis treated with needle joint aspiration succeed in all patients younger than 1 year and in all patients between 1 and 3 years with a CRP<20 mg/L. Alternative treatment such as arthroscopy debridement should be early considered in patients older than 3 years and patients between 1 and 3 years with CRP>20 mg/L.
Level Of Evidence:
Level III.