When do we have to Operate? A Re-evaluation of Repeated Aspirations of the Hip Joint for Septic Arthritis

Background: Septic arthritis of the hip joint (SAHJ) is usually treated with arthrotomy and drainage, associated with drain problems, scarring and joint instability. Repeated aspirations of the hip joint in children with SAHJ, were reported twenty years ago, are still used successfully and became the standard of care in Israel. In the recent years, several children did not respond to the treatment as expected and underwent hip joint arthrotomies. The aim of this research was to identify the characteristics of the operated group.

Methods: We conducted a retrospective analysis of the children who were diagnosed with SAHJ and treated with repeated aspirations, at the Sheba Medical Center, between 2005-2017. We divided the patients into 2 groups: children who responded to this method and children who did not improve clinically and required an arthrotomy. The data was extracted from the children’s’ charts.

Results: We have identified 64 patients with complete data; 58 children (90.63%) were treated successfully with repeated aspirations and 6 children (9.37%) did not improve and were treated surgically. Five out of 58 children from the control group (8.6%) and 5 out of 6 from the arthrotomy group (83.3%) had chronic comorbidities (p=0.0002). The patients who responded to aspiration had 1.3 days of fever compared to 5.3 days in the operated group (p=0.0101). The level in C-Reactive Protein (CRP) before and after the first aspiration decreased by 12.2 mg/l in the aspirated group and increased by 73.7mg/l in the operated group (p=0.0015)

Conclusions: Children with SAHJ respond well to treatment with repeated aspirations of the joint, which is both safe and effective. Patients who have more chronic comorbidities, have more days of fever, and show an increase of CRP after the first aspiration are more likely to require a hip arthrotomy.