Abstract
Purpose Primary septic arthritis of the hip is a rare differential diagnosis of acute hip pain in adults, but if it is not diagnosed and treated in time, it often leads to irreversible joint damages. However, the diagnostic options of primary septic arthritis of the hip are limited. The accurate aspiration is difficult to achieve, and the traditional open arthrotomy is invasive and associated with high rates of potential complications. We used hip arthroscopy for the diagnosis and intervention of primary septic arthritis of the hip in adults and evaluated their safety and efficacy.
Methods Seven patients (4 female, 3 male), average age 48±17.3 years with unexplained acute pain and limited hip joint were included. Septic arthritis was confirmed by aspirated joint fluid analysis or synovial pathology. Surgical treatment consisted of immediate arthroscopic lavage using only 2 portals for debridement, high-volume irrigation, partial synovectomy, and drainage. Antibiotics were used according to drug susceptibility results or empirically. The symptoms, related primary disease, levels of inflammatory indicators, bacterial culture results, surgical complications, duration of antibiotic use, and follow-up results were all recorded and analyzed.
Results The median duration of symptoms prior to the arthroscopic lavage was 11.6 (4-45) days. All patients had different degrees of leukocytosis and elevated level of erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP). 2 cases got positive results of preoperative bacterial culture results, and 6 cases got positive results of postoperative bacterial culture results, among which Staphylococcus aureus was the most frequently detected pathogen (3 cases). Antibiotics were administered for 4-6 weeks. After an average of 43 days after surgery, CRP returned to physiological levels, ESR returned to normal in 54 days, and after follow-up for 6 months, the average score of Visual Analogue Scale (VAS) decreased from 6.4±1.3 points to 1.3±0.2 points (p<0.05), and the average score of modified harris hip score（mHHS） increased from 53±9.8 points to 85±8.6 points (p < 0.05). None of the patients had significant surgical complications. During the mean follow-up for 24 months (range 18–30 months), no patient showed recurrence of infection, while 1 case underwent subsequent total hip arthroplasty due to serious destruction of articular cartilage and rapidly progressive degeneration.
Conclusion Hip Arthroscopic therapy is a safe and effective method for the diagnosis and intervention of primary septic arthritis of the hip without dissemination, which is reliable, tends to be less invasive and more thorough than the traditional open arthrotomy.