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A systematic review of the optimal drainage technique for septic hip arthritis in children
Cornelia Maria Donders1, Anne J Spaans2, Johannes H J M Bessems3,4
1Department of Orthopaedic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
Insights
For pediatric septic hip arthritis, arthrocentesis and arthroscopy may require more procedures than arthrotomy. However, arthrotomy can lead to worse long-term outcomes, despite low-quality evidence.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Surgical Techniques
Background:
- Septic arthritis commonly affects the pediatric hip joint.
- Drainage methods include arthrocentesis, arthroscopy, and arthrotomy.
Purpose of the Study:
- To systematically review and identify the most effective drainage technique for pediatric septic hip arthritis.
Main Methods:
- Systematic search of MEDLINE, EMBASE, and Cochrane databases.
- Inclusion of 19 studies (406 hip joints) assessing drainage techniques.
- Evaluation of outcomes: additional procedures, clinical results, and radiological sequelae.
- Quality assessment using the Methodological Index for Non-randomized Studies (MINORS).
Main Results:
- Arthrocentesis required further procedures in 15% of cases, arthroscopy in 14%, and arthrotomy in 3%.
- Arthrotomy was associated with poorer clinical outcomes and more radiological sequelae.
- Meta-analysis was not feasible due to study heterogeneity and low quality (MINORS median 4).
Conclusions:
- Arthrocentesis and arthroscopy may have a higher need for subsequent procedures compared to arthrotomy.
- Arthrotomy might be linked to inferior long-term outcomes.
- The literature on pediatric septic hip arthritis treatment is characterized by diverse, low-quality studies.
Introduction:
The hip is one of the most commonly affected joints in paediatric septic arthritis. Drainage can be performed using arthrocentesis (articular needle aspiration), arthroscopy or arthrotomy. The objective of this systematic review was to identify the most effective drainage technique for septic hip arthritis in the paediatric population.
Materials And Methods:
The electronic MEDLINE, EMBASE and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the paediatric hip. Outcome parameters were additional drainage procedures, clinical outcomes and radiological sequelae. The quality of each of the included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) score.
Results:
Out of 2428 articles, 19 studies with a total of 406 hip joints were included in the systematic review. Additional arthroscopy or arthrotomy was performed in 15% of the hips treated with arthrocentesis, in 14% after arthroscopy and in 3% after arthrotomy. Inferior clinical outcomes and more radiological sequelae were seen in patients treated with an arthrotomy. A meta-analysis could not be performed due to the diversity and low quality of the studies (MINORS median 4 [range 2-15]).
Conclusions:
This systematic review gives a comprehensive overview of the available literature on treatment for septic hip arthritis in children. Arthrocentesis and arthroscopic procedures may have a higher risk of additional drainage procedures in comparison with arthrotomy. However, arthrotomy might be associated with inferior outcomes in the longer term. The included studies are diverse and the scientific quality is generally low.
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