Arthroskopische Behandlung von septischen Hüftgelenksinfekten im Kindes- und Jugendalter

Abstract

Irrigation of the hip joint by hip arthrotomy represents the standard treatment for septic arthritis of the hip in childhood and adolescence. Arthroscopic lavages for treating a septic knee, elbow, ankle and glenohumeral joints are well established, but have only reached little acceptance in the therapy of septic hip arthritis in children. The goal of this study is to evaluate the advantages of the minimally invasive arthroscopic high-volume lavage for septic hip arthritis with regards to treatment safety and complication frequency. 20 children aged 6.4 years on average (2-14 years) with obvious signs of septic arthritis of the hip proven clinically and by blood tests were arthroscopically treated in a 2-portal technique. In a prone position on a standard table the patient had the arthroscopic lavage procedure followed by insertion of a Redon tube. In all cases a histological sample and a bacterial swab were taken. A traction table was not used. In three children there was a stage I according to Stutz and Gächter, in thirteen a stage II and in four patients a stage III. Because of a concomitant femoral neck osteomyelitis in three cases and an osteomyelitis of the os pubis in a single patient, PMMA mini chains were locally administered. The histological samples were reported as purulent in 16 and as non-specific synovitis in four patients. In ten children a positive bacterial result was given, with Staphylococcus aureus found in 7 cases and single cases with Meningococci, Salmonella and Staphylococcus warneri. All patients received an intravenous antibiotic treatment for 14 days followed by four weeks of oral antibiotics. 16 out of 20 children were sufficiently treated by one single arthroscopic lavage. In three cases with additional osteomyelitis a secondary procedure was needed for removal of the antibiotic chain. During follow-up after an average of 2.9 years 19 of 20 children demonstrated a free range of hip joint motion and a full sporting activity without any restrictions. One girl with stage III arthritis and a preoperative duration of symptoms of seven days developed a femoral head necrosis and chondrolysis with hip joint subluxation. The other 19 patients regained an excellent Harris hip score at follow-up, whereas the girl only produced moderate score values. So, 19 children had an unrestricted function of their hips on the same activity level as before. The 2-portal hip arthroscopy with high-volume lavage represents a safe and minimally invasive method in order to successfully treat septic arthritis of the hip and concomitant femoral neck osteomyelitis in children and adolescents. This technique leads to a very low morbidity offering all advantages of arthroscopic procedures. The use of cannulated instruments through well established safe portals makes this arthroscopic lavage procedure a simple and easily adoptable technique.