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Is choice of approach associated with risk of avascular necrosis in pediatric septic hip?
Shrey Nihalani1,2, Francis Cruz1,2, Jacob K Hawkins1,2
1Children's Hospital of Alabama, Birmingham, AL, USA.
Insights
The medial approach for pediatric septic hip surgery is as safe as the anterior approach regarding avascular necrosis risk. This study found no significant difference in avascular necrosis rates between surgical methods for pediatric hip infections.
Area of Science:
- Orthopedic Surgery
- Pediatric Infectious Diseases
- Surgical Outcomes
Background:
- Septic arthritis of the hip is a common pediatric condition requiring prompt treatment.
- The anterior surgical approach is traditionally favored to avoid avascular necrosis (AVN) from medial femoral circumflex artery injury.
- Limited comparative data exists for surgical approaches in pediatric septic hip cases.
Purpose of the Study:
- To compare the rates of avascular necrosis (AVN) in pediatric patients undergoing surgical irrigation and debridement for septic hip via anterior versus medial approaches.
- To test the hypothesis that the medial approach does not significantly increase the risk of AVN compared to the anterior approach.
Main Methods:
- Retrospective review of pediatric septic hip cases treated with irrigation and debridement.
- Comparison of AVN development between patients treated with anterior and medial surgical approaches over an 18-year period.
- Primary outcome: incidence of avascular necrosis.
Main Results:
- Avascular necrosis (AVN) developed in 7.9% of patients (13 of 164).
- The rate of AVN was not significantly different between the anterior (9/101) and medial (4/63) approaches (p=0.76).
- Patients who developed AVN were significantly older (10.0 vs 6.8 years, p=0.01) and had longer follow-up (3.3 vs 1.5 years, p=0.01).
Conclusions:
- The medial surgical approach for pediatric septic hip is not associated with an increased risk of avascular necrosis compared to the anterior approach.
- This finding challenges traditional concerns and suggests the medial approach may be a viable alternative for pediatric septic hip treatment.
Purpose:
Septic arthritis of the hip in children and adolescents is a common condition requiring timely diagnosis and intervention. Surgical irrigation and debridement is typically performed through the anterior approach because of concerns about injury to the medial femoral circumflex artery leading to avascular necrosis. While there are multiple studies investigating the sequelae of anterior and medial approaches for reduction of developmental dislocation of the hip, none have compared these approaches for the pediatric septic hip. We hypothesize that there will be no significant difference in the rate of avascular necrosis when comparing the medial and anterior approaches to the septic hip in pediatric patients.
Methods:
A retrospective review was performed of pediatric septic hips treated with irrigation and debridement through either a medial or anterior approach at a single institution over an 18-year period of time. The primary outcome measure was the development of avascular necrosis.
Results:
Thirteen of 164 patients (7.9%) developed avascular necrosis. Avascular necrosis was noted in 9 of 101 patients who had anterior approach and 4 of 63 patients who underwent medial approach (p = 0.76). The average age for patients developing avascular necrosis was 10.0 years old versus 6.8 years old in patients who did not develop avascular necrosis (p = 0.01). The average follow-up was 3.3 years in patients with avascular necrosis versus 1.5 years for patients who did not develop avascular necrosis (p = 0.01).
Conclusion:
Medial approach to the pediatric septic hip does not increase the rate of avascular necrosis compared to the anterior approach.
Level Of Evidence:
Retrospective comparison study, Level III.
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