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Aspiration or arthrotomy for paediatric septic arthritis of the shoulder and elbow: a systematic review
Anne J Spaans1, C M Lilian Donders2, J H J M Gert Bessems3,4
1Department of Orthopaedic Surgery, Sint Maartenskliniek Nijmegen/Boxmeer, the Netherlands.
Insights
Septic arthritis in children
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Surgical Techniques
Background:
- Septic arthritis of the upper extremity in children presents treatment challenges.
- Optimal drainage techniques remain debated in current literature.
Purpose of the Study:
- To systematically review and identify the most effective drainage technique for pediatric upper extremity septic arthritis.
Main Methods:
- Systematic search of MEDLINE, EMBASE, and Cochrane databases.
- Inclusion of studies reporting outcomes of aspiration, arthroscopy, or arthrotomy for pediatric shoulder or elbow septic arthritis.
- Analysis of clinical improvement, need for re-operation, and complications.
Main Results:
- Seven studies with 171 patients were included; most were retrospective.
- No significant difference in radiological or clinical outcomes between aspiration and arthrotomy.
- Aspiration required additional procedures in 44% of cases, versus 12% for arthrotomy.
Conclusions:
- Both aspiration and arthrotomy yield good clinical results for pediatric shoulder and elbow septic arthritis.
- Aspiration may carry a higher risk of requiring subsequent drainage procedures.
- Low scientific quality of existing studies necessitates cautious interpretation.
Abstract:
Upper extremity arthritis in children can be treated with joint aspiration, arthroscopy or arthrotomy, followed by antibiotics. The literature seems inconclusive with respect to the optimal drainage technique. Therefore, the objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the upper extremity in children.Two independent investigators systematically searched the electronic MEDLINE, EMBASE and Cochrane databases for original articles that reported outcomes of aspiration, arthroscopy or arthrotomy for septic arthritis of the paediatric shoulder or elbow. Outcome parameters were clinical improvement, need for repetitive surgery or drainage, and complications.Out of 2428 articles, seven studies with a total of 171 patients treated by aspiration or arthrotomy were included in the systematic review. Five studies reported on shoulder septic arthritis, one study on elbow septic arthritis, and one study on both joints. All studies were retrospective, except for one randomized prospective study. No difference was found between type of treatment and radiological or clinical outcomes. Aspiration of the shoulder or elbow joint required an additional procedure in 44% of patients, while arthrotomy required 12% additional procedures.Conclusion: Both aspiration and arthrotomy can achieve good clinical results in children with septic arthritis of the shoulder or elbow joint. However, the scientific quality of the included studies is low. It seems that the first procedure can be aspiration and washout and start of intravenous antibiotics, knowing that aspiration may have a higher risk of additional drainage procedures. Cite this article: EFORT Open Rev 2021;6:651-657. DOI: 10.1302/2058-5241.6.200122.
