title: Hip septic arthritis in children: assessment of treatment using needle aspiration/irrigation.
abstract: BACKGROUND
  This retrospective series evaluated the surgical treatment of hip arthritis in children by needle aspiration-irrigation alone.
  
  
  METHODS
  Forty-three cases of septic hip arthritis were treated by needle aspiration-irrigation under general anesthesia associated with intravenous then oral administration of antibiotics. Clinical and biological criteria at admission, during hospitalization and at final follow-up were studied to identify any criteria carrying a predictive value for unsuccessful needle aspiration-irrigation.
  
  
  RESULTS
  Thirty-eight hips had a favorable outcome in this series, while secondary open arthrotomy was required in five hips for further irrigation. Common criteria found in the group requiring open arthrotomy were a diagnosis delay of at least 6 days between initial clinical symptoms and treatment as well as markedly abnormal biological results at admission. A threshold for the predictive value of certain variables was identified including C-reactive protein above 100, white polynuclear blood count above 15000, and sedimentation rate above 25 in the first hour and 50 in the second hour.
  
  
  CONCLUSIONS
  Treatment modalities for septic arthritis of the hip remain controversial in children and various techniques have been shown to be effective in the literature. Needle aspiration-drainage, the least invasive of these, has been shown to have good results, even in the hip, even though this is a deep, tight, joint which is known to be difficult to drain. Prognostic criteria are difficult to identify, however all authors agree that delayed treatment makes evacuation of intra-articular debris especially difficult.
  
  
  CONCLUSIONS
  Needle aspiration-irrigation is effective in septic arthritis of the hip, as long as basic principles are followed. Delayed treatment and certain biological criteria should be taken into account when selecting a treatment, since negative predictive criteria identified in this series were present in the five hips requiring secondary arthrotomy.
authors: Department of Pediatric Orthopaedic Surgery, Nancy Teaching Hospital Center, Children Hospital, 5, allée du Morvan, 54511 Vandœuvre, France. p.journeau@chu-nancy.fr
authors: P
authors: P
authors: Journeau
authors: F
authors: F
authors: Wein
authors: D
authors: D
authors: Popkov
authors: R
authors: R
authors: Philippe
authors: T
authors: T
authors: Haumont
authors: P
authors: P
authors: Lascombes
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001170:Arthritis, Infectious / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D008297:Male; D009339:Needles; D012189:Retrospective Studies; D013396:Suction / Q000295:instrumentation*; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents