Primary Septic Arthritis of Hip Joint (SAHJ) can be Safely Treated by Single or Repeated Aspiration in Most Children

As displayed in previous research, the commonly accepted practice in Israeli hospitals, counter to the literature, for SAHJ is repeated aspirations. In line with this, the policy in our pediatric orthopedic unit is to perform single or repeated aspiration in the initial 48 hour period. Continued treatment is decided by further clinical evaluation. Our goal in this paper is to evaluate the justification for this practice.

We performed a retrospective analysis of all pediatric patients hospitalized with a diagnosis of primary SAHJ in this istitution from 2000 until 2017 and compared patients that had undergone surgery with those treated with repeated aspirations alone.

70 children (44 male and 26 female, mean age of 5, range 0 to 18 years) were included. 65(92.9%) were treated with aspiration as the initial treatment. Of the patients initially treated with aspiration, 14(21.5%) subsequently required arthrotromy. Of the 51(78.5%) children treated by aspiration alone, 26(51%) improved after a single aspiration and 25(49%) required additional aspirations (2-3 in total). All but 1 patient showed good clinical recovery and were discharged with continued antibiotics. In the early period of this study 2(2.9%) patients were treated by arthrotomy as the initial treatment.

This study shows that most children with SAHJ can be safely treated by aspiration in conjunction with IV antibiotics. An interesting finding was that many children (26, 37%) required only a single aspiration to achieve clinical improvement. Only a minority of patients, who do not improve with this treatment, require subsequent arthrotomy.