Is Initial Treatment of Pediatric Septic Arthritis of the Hip Joint in Israel Different from Accepted Textbook Practice?

Septic arthritis of the hip joint (SAHJ) is considered an orthopedic surgical emergency, where the presence of a microbial agent can cause irreversible damage due to the chondrolytic effect of pus. It is universally agreed upon that pediatric SAHJ requires prompt recognition and treatment. According to medical textbooks, there is only one form of initial treatment; aspiration followed by irrigation and debridement (by arthroscopy or arthrotomy). In the last few years, it has been reported that there are practitionors who are performing aspiration alone.

In May 2017, we surveyed a sample population of senior pediatric orthopedic and infectious disease doctors practicing throughout Israel using an anonymous questionnaire. The purpose was to assess their personal and departmental approaches to cases of pediatric SAHJ. We hypothesized that the standard practice for initial treatment was different in Israel than the universal accepted care.

The data was recorded, tabulated, and analyzed to understand the different medical approaches and assess the prevalence of such practices.

According to the survey, all 22 doctors agreed that when approaching a classic case of pediatric SAHJ, aspiration was needed. Yet, 0 out of the 22 physicians answered that they would continue on to debridement (by arthroscopy or arthrotomy), in contrast with universal practice.

The stark difference between the treatment practices for pediatric SAHJ in Israel compared to the accepted treatment found in medical literature gives strong support to the validity of our hypothesis. This phenomenon was previously mentioned discussing a limited local hospital (Sheba Safra Children’s Hospital), but until now has never been demonstrated on a larger countrywide scale. The results from the survey display the widespread difference in the standard of initial treatment in Israel and invite further investigation into Israel’s prognosis and outcomes in handling this disease.