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Diagnosis and surgical treatment of chronic destructive septic hip arthritis
Zhishuo Zhang1,2,3,4, Zida Huang1,2,3,4, Xinyu Fang1,2,3,4
1Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Insights
Chronic destructive septic hip arthritis (SHA) lacks standardized diagnosis and treatment. Metagenomic sequencing aids diagnosis, while one-stage spacer implantation plus two-stage arthroplasty is the current standard surgical approach.
Area of Science:
- Orthopedics
- Infectious Diseases
- Surgical Innovation
Background:
- Septic hip arthritis (SHA) is a rare but severe condition.
- Significant debate surrounds the definition, diagnosis, and management of chronic destructive SHA.
- Lack of standardized classification for SHA complicates clinical practice.
Purpose of the Study:
- To review current diagnostic and therapeutic strategies for chronic destructive SHA.
- To identify promising diagnostic tools like metagenomic next-generation sequencing.
- To evaluate existing and novel surgical treatments for SHA.
Main Methods:
- Comprehensive literature review of diagnostic and treatment modalities for chronic destructive SHA.
- Analysis of diagnostic criteria including clinical history, bacterial culture, and histopathology.
- Evaluation of surgical interventions: debridement, Girdlestone resection, and various arthroplasty techniques.
Main Results:
- Diagnosis requires integrating multiple factors; metagenomic next-generation sequencing shows promise.
- Established treatments include debridement, Girdlestone resection, and staged arthroplasty.
- One-stage spacer implantation with two-stage arthroplasty is the current standard, offering high success and low reinfection rates.
- One-stage arthroplasty is an emerging option with specific indications and limitations.
Conclusions:
- Chronic destructive SHA necessitates a multi-faceted diagnostic approach.
- Current surgical standards favor staged arthroplasty, though one-stage arthroplasty presents potential advantages.
- Further high-quality research is essential to refine diagnostic and therapeutic decision-making for SHA.
Abstract:
Septic hip arthritis (SHA) is a relatively rare but hazardous disease. Much controversy exists regarding the definition, diagnosis and treatment of chronic destructive SHAs. This review aims to provide an overview of the diagnostic and therapeutic approaches for chronic, destructive SHA and suggest possible research directions for this disease's future diagnosis and treatment. There is no unified naming or classification standard for SHAs. Chronic destructive SHA still requires a comprehensive diagnosis combining history, signs, bacterial culture, histopathological examination, inflammation and other indicators, of which metagenomic next-generation sequencing is a promising diagnostic tool. Previous treatment options for this disease include debridement, debridement + Girdlestone femoral head and neck resection, and debridement + Girdlestone femoral head and neck resection + two-stage arthroplasty. Among them, one-stage spacer implantation + two-stage arthroplasty is the current standard surgical option with a high success rate and low reinfection rate, while one-stage arthroplasty is a new treatment option proposed in recent years with unique advantages but limitations in terms of surgical indications. In the future, more high-quality studies are needed to provide the latest evidence to support clinical decision-making.
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