Arthroscopic Treatment for Primary Septic Arthritis ofthe Hip in Adults

Primary septic arthritis is a rare differential diagnosis of acute hip pain in adults. Inspired by the success of all-arthroscopictreatment in pediatric patients, we developed a diagnostic and surgical pathway for our adult patients.Methods.Seven patients,average age44 ± 13.7years with acute hip pain since4.4 ± 2.9days in the average, were included. Septic arthritis was confirmedby joint aspiration and dissemination was excluded by MRI and standard radiographs. Surgical treatment consisted of immediatearthroscopic lavage using 4 portals for debridement, high-volume irrigation, partial synovectomy, and drainage.Results.Patientsweretreatedinhospitalfor12.4 ± 3.1days (range 7–16 days). WBC and CRP returned to physiological levels. During the meanfollow-up of26.4±19.4months (range 13–66 months) no patient showed recurrence of infection. The 5 patients with an unimpairedhip joint prior to the infection had a mean modified Harris Hip Score of94±5.6points (range 91–100) at final follow-up.Conclusions.Arthroscopic therapy using a minimally invasive approach with low perioperative morbidity for the treatment of primary septicarthritis of the adult hip is able to restore normal hip function in acute cases without dissemination of the infection.Level of Evidence.IV