Percutaneous drainage of septic hip arthritis in children

Abstract

INTRODUCTION: Hip arthritis is a therapeutic emergency which requires sure diagnosis and pus evacuation. Two methods are presently in use: isolated or oriterative punction and arthrotomy. TECHNIQUE: A Pleurocath is introduced under general anesthesia and under fluoroscopic control by an obturator approach. It contains a perforated trocart which allows a flexible catheter, perforated over the last few centimeters to be inserted. The introduction point must be as far posterior as possible, in the plane of the anterior border of the femoral neck to promote declivious downward. It allows for pus evacuation, confirmation of the diagnosis and bacteriological samples to be taken. The lavage is done using ionized polyvidone dilution in physiological saline solution. The catheter is inserted in the center of the trocart and pushed intra-articularly under fluoroscopic control. The trocart is pulled out. The catheter is fixed on the skin using non resorbable thread. An occlusive dressing is made. A three way cock is installed for aspiration and lavage. Drainage is declivious. MATERIAL AND METHODS: This percutaneous drainage technique was used in three cases of septic hip arthritis in children. Treatment associated drainage, immobilization by traction and double or triple intravenous antibiotics. The hips healed without any detrimental effects. DISCUSSION: The punction had both a diagnosis and a therapeutic objective, as it allows pus evacuation in the same time. It can be repeated according to the patient's progress. Most authors prefer arthrotomy with careful lavage and good drainage. We suggest an intermediate technique which includes punction and allows clinical and bacteriological diagnosis, joint lavage and drainage. Using permanent drainage, the hip joint is protected from high pressure. It makes repeated lavage possible when the pus is thick, and avoids the drain from becoming plugged. CONCLUSION: This approach enables the pus to be evacuated, bacteriological samples to be taken, lavage and drainage. The drainage must be left until apyrexia and normal biological inflammation criteria are obtained.