Arthroscopic surgery for septic arthritis of the hip joint in 4 adults

PURPOSE: Arthroscopic surgery for septic coxarthritis has not become a well-established technique despite its minimally invasive nature. The authors performed arthroscopic surgery and intraoperative high-volume irrigation on 4 adult patients with septic coxarthritis. This minimally invasive procedure was successful in treating these patients, and there was no recurrence of arthritis or other complications. The purpose of this article is to introduce this 3-directional-approach method of arthroscopic surgery for septic coxarthritis. Type of Study: Case study of arthroscopic surgery for septic arthritis of the hip joint in 4 adults. METHODS: There were 3 women and 1 man with an average age of 58 years. The length of time from onset of symptoms to surgery averaged 36 days. One patient had diabetes; another had subarachnoid hemorrhage and was being treated with steroidal drugs. The etiologic agent was found to be Staphylococcus aureus infection in 2 patients, Serratia sp. in 1 patient, and group-B Streptococcus in 1 patient. Three-directional-approach arthroscopic surgery and intraoperative high-volume irrigation were performed using 20 to 25 L of physiologic saline on the 4 patients. Continuous postoperative intra-articular irrigation was not performed. RESULTS: Inflammatory reactions subsided within 4 weeks of surgery in 3 of the 4 patients and within 6 weeks in the other patient. At the time of the final examination, the postoperative follow-up period ranged from 1 to 6 years and none of the patients had ankylosis of the hip joint. CONCLUSIONS: Three-directional-approach arthroscopic surgery in combination with intraoperative large-volume irrigation is an effective technique for treating septic arthritis of the hip joint because the joint can be preserved and it is less invasive than other open arthrotomy techniques.