The feasibility and safety of ultrasound-guided puncture for treatment of septic arthritis in children

Abstract Background We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance. Methods We retrospectively included 67 children (mean age, 3.0 years; range: 1 month–12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up. Results We found no significant difference between the groups. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications. Conclusions US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery. Trial registration IRB-MTP_2021_05_202100781 Level of evidence: IV (case series)