Artikel
Arthrotomy versus repeated aspiration-lavage in the treatment of septic arthritis of the hip in children
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Autoren
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Eugen Cohen
- Soroka Medical Center, Orthopedic Department, Ben Gurion University, Beer Sheva, Israel
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Yuri Klassov
- Soroka Medical Center, Orthopedic Department, Ben Gurion University, Beer Sheva, Israel
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Eugene Leibovitz
- Soroka Medical Center, Pediatric Infectious Disease Unit, Ben Gurion University, Beer Sheva, Israel
| Veröffentlicht: | 26. Oktober 2021 |
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Gliederung
Text
Objectives: To compare needle aspiration-lavage versus formal arthrotomy in the treatment of septic arthritis of the hip (SAH) in children.
Methods: We analyzed the management and outcome of SAH by evaluating: a) Scar appearance assessed by Patient and Observer Scar Assessment Scale (POSAS). We considered satisfactory results (no scar discomfort) when POSAS was within 10% of ideal score; b) 24-hours post-operative pain by Visual Analog Scale (VAS); c) Complication rates of incomplete drainage (re-arthrotomy and modification of therapy from aspiration-lavage to arthrotomy). The results were evaluated by Student t-test or by Chi Square test. The correlation between time from intervention to the POSAS scoring was assayed using several Spearman correlation tests.
Results: 79 children aged 2-14 years admitted during 2006-2015 and available for follow-up were enrolled (Table 1 [Tab. 1]).
The POSAS score (range 12-120 points) reflecting scar appearance at the latest follow-up was higher in the arthrotomy group compared with the aspiration-lavage group (18.10±6.22 versus 12.27±1.40, p<0.001), but 77.4 % of patients treated by arthrotomy had no scar discomfort (Table 2 [Tab. 2]).
The 24-hours post-intervention VAS (range 1-10) was 5.06 ±1.29 after arthrotomy and 4.03 ±1.13 after aspiration-lavage, p< 0.04. 3/34 (8.8%) patients in the arthrotomy group and 12/45 (26.7%) in the aspiration-lavage group had complications (p=0.045).
Conclusions:
- 1.
- The arthrotomy and aspiration-lavage procedures are both consuming operating room resources, but while arthrotomy is usually a definitive procedure, serial aspirations and repeated anesthesia are often required for patients who underwent aspiration-lavage.
- 2.
- The scar quality in the aspiration-lavage group was superior than in the arthrotomy group; however, the majority of patients in the arthrotomy group reported no scar discomfort.
- 3.
- The pain level 24 hours after intervention was lower in the aspiration-lavage group.
- 4.
- Complications were three times more frequent in the aspiration-lavage group.
- 5.
- Our results provide evidence for the use of arthrotomy as a safe method of drainage in the treatment of SAH by offering effective drainage following only one surgical procedure.
- 6.
- Minor scar disturbances recorded in the arthrotomy group may outweigh the risk of complications encountered in the aspiration-lavage group. If drainage of aseptic hip in is required in pediatric population, we suggest arthrotomy as the technique of choice. As institutional settings may differ among medical centers, our conclusions have to be adapted to local conditions.
