Outcomes and Complications of Arthroscopic Treatment for Septic Arthritis of the Hip: A Systematic Review

Document Type : SYSTEMATIC REVIEW

Authors

1 Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

2 Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 School of Medicine, Iran University of Medical Sciences, Tehran, Iran

4 International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

10.22038/abjs.2024.80263.3668

Abstract

Objectives: The exact role and safety of arthroscopy in SAH management remain contentious. This 
systematic review aims to assess the outcomes and complications of arthroscopic treatment, shedding 
light on its efficacy and safety profile.
Methods: Following PRISMA guidelines, searches were conducted in PubMed, Scopus, Embase, and Web of 
Science until January 25, 2024. Eligible studies included SAH patients undergoing arthroscopic treatment. Data 
extraction covered demographics, clinical findings, and functional outcomes. Quality assessment used NIH case 
series assessment and Newcastle-Ottawa Scale. Quantitative analysis focused on Hip Harris Score, post-operative 
pain rate, and revision rate using a random-effects model. Comprehensive Meta-Analysis (CMA) software version 
3.3 facilitated analyses.
Results: The primary search yielded 1,662 articles, after screening the records, 35 study included. In case report 
studies, 18 patients were analyzed with an average age of 33.7 years. Complications included joint ankylosis, 
osteonecrosis, muscle atrophy, and osteopenia. Revision surgery was performed in three cases, with one due to 
infection. In case series studies, 295 patients with an average age of 15.6 years had complications such as joint 
collapse, femoral nerve palsy, and avascular necrosis. Thirteen revision cases were reported. Among 18 case 
series, arthroscopic complications were noted in nine studies, while six studies reported none. Full range of motion 
was achieved in 13 studies, and pain resolution in 11.
Conclusion: Utilizing arthroscopic techniques for treating septic arthritis of the hip represents a safe, effective, and 
minimally invasive choice, demonstrating favorable clinical results, relatively low rates of revision and complications, 
and rapid rehabilitation periods.
 Level of evidence: IV

Keywords

Main Subjects

References

  1. Harada K, McConnell I, DeRycke EC, Holleck JL, Gupta S. Native Joint Septic Arthritis: Comparison of Outcomes with Medical and Surgical Management. South Med J. 2019; 112(4):238-43.doi:10.14423/smj.0000000000000958.
  2. Kao FC, Hsu YC, Liu PH, Tu YK, Jou IM. High 2-year mortality and recurrent infection rates after surgical treatment for primary septic arthritis of the hip in adult patients: An observational study. Medicine (Baltimore). 2019;98(32):e16765.doi:10.1097/md.0000000000016765.
  3. Lee YK, Park KS, Ha YC, Koo KH. Arthroscopic treatment for acute septic arthritis of the hip joint in adults. Knee Surg Sports Traumatol Arthrosc. 2014; 22(4):942-5. doi:10.1007/s00167-012-2283-0.
  4. Thompson RM, Gourineni P. Arthroscopic Treatment of Septic Arthritis in Very Young Children. J Pediatr Orthop. 2017;37(1):e53-e7.doi:10.1097/bpo.0000000000000659.
  5. Tahmasebi MN, Sharafat Vaziri A, Miresmaeili SH, Bozorgmanesh MR, Mirkarimi S, Zehtab MJ, Tahami M. Two-stage Total Knee Arthroplasty for Treatment of Surgical Failure of Septic Arthritis in Degenerative Knee Joints. Arch Bone Jt Surg. 2020; 8(4):524-30.doi:10.22038/abjs.2020.43184.2178.
  6. Poursalehian M, Lotfi M, Mortazavi SMJ. Latent infections in conversion total hip arthroplasty following internal fixation of femoral neck fractures: a systematic review and meta-analysis of diagnostic methods. Arch Orthop Trauma Surg. 2024:1-9. doi:10.1007/s00402-024-05216-6.
  7. Vassallo C, Borg AA, Farrugia D, Mercieca C. The Epidemiology and Outcomes of Septic Arthritis in the Maltese Islands: A Hospital-Based Retrospective Cohort Study. Mediterr J Rheumatol. 2020; 31(2):195-205. doi:10.31138/mjr.31.2.195.
  8. Lipatov KV, Asatryan A, Melkonyan G, Kazantcev AD, Solov'eva EI, Cherkasov UE. Septic arthritis of the hand: Current issues of etiology, pathogenesis, diagnosis, treatment. World J Orthop. 2022 18; 13(7):622-30. doi:10.5312/wjo.v13.i7.622.
  9. Mue D, Salihu M, Awonusi F, Yongu W, Kortor J, Elachi I. The epidemiology and outcome of acute septic arthritis: a hospital based study. J West Afr Coll Surg. 2013; 3(1):40-52.
  10. Balato G, de Matteo V, Ascione T, de Giovanni R, Marano E, Rizzo M, Mariconda M. Management of septic arthritis of the hip joint in adults. A systematic review of the literature. BMC Musculoskelet Disord. 2021 2; 22(Suppl 2):1006. doi:10.1186/s12891-021-04843-z.
  11. Barik S, Raj V, Prasad SG, Richa, Garg V, Singh V. Comparison of Various Joint Decompression Techniques in Septic Arthritis of the Hip in Children: A Systematic Review and Meta-Analysis. Hip Pelvis. 2023; 35(2):73-87. doi:10.5371/hp.2023.35.2.73.
  12. Luo H, He C, Zhao Y, Yang G, Hong H. Outcomes of single- vs two-stage primary joint arthroplasty for septic arthritis: a systematic review and meta-analysis. EFORT Open Rev. 2023 1;8(9):672-9. .doi:10.1530/eor-22-0142.
  13. Sharma A, Gupta S, Sethi A, Singh J. A Midterm Analysis of Outcomes of Septic Arthritis of Hip Treated With Two Stage Cement Spacer and Total Hip Arthroplasty. Arch Bone Jt Surg. 2024; 12(10):690-4.doi:10.22038/abjs.2024.67176.3193.
  14. Poursalehian M, Javadzade E, Mortazavia SJ. Recent Trends and Hotspots in Hip Arthroplasty: A Bibliometric Analysis and Visualization Study of Last Five-Year Publications. Arch Bone Jt Surg. 2023; 11(8):493-501.doi:10.22038/abjs.2023.70790.3313.
  15. Poursalehian M, Ebrahimzadeh MH, Javadzade E, Mortazavi SJ. Recent Trends and Hotspots in Knee Arthroplasty: A Bibliometric Analysis and Visualization Study of the Last Five-Year Publications. Arch Bone Jt Surg. 2023; 11(9):545-55.doi:10.22038/abjs.2023.70791.331.
  16. Abrishami R, Aghili SH, Afshar C, Farhang Ranjbar M, Nasrollahizadeh A, Poursalehian M. Long-term outcomes of converting fused hips to total hip arthroplasty are satisfactory: a systematic review and meta-analysis. Ann Med Surg (Lond). 2024; 86(6):3391-9. doi:10.1097/ms9.0000000000002024.
  17. Duman S, Camurcu Y, Ucpunar H, Çöbden A, Karahan N, Sofu H. Arthroscopic Treatment of Acute Septic Arthritis of the Hip Joint in Pediatric Patients Aged 10 Years or Younger. Arthroscopy.2020;36(2):464-72. doi:10.1016/j.arthro.2019.08.031.
  18. de SD, Cargnelli S, Catapano M, Peterson D, Simunovic N, Larson CM, Ayeni OR. Efficacy of Hip Arthroscopy for the Management of Septic Arthritis: A Systematic Review. Arthroscopy.2015;31(7):1358-70. doi:10.1016/j.arthro.2014.12.028.
  19. Nusem I, McAlister A. Arthroscopic lavage for the treatment of septic arthritis of the hip in children. Acta Orthop Belg. 2012;78(6):730-4.
  20. Kim SJ, Choi NH, Ko SH, Linton JA, Park HW. Arthroscopic treatment of septic arthritis of the hip. Clin Orthop Relat Res. 2003(407):211-4.doi:10.1097/00003086-200302000-00030.
  21. Fukushima K, Uekusa Y, Koyama T, Ohashi Y, Uchiyama K, Takahira N, Takaso M. Efficacy and safety of arthroscopic treatment for native acute septic arthritis of the hip joint in adult patients. BMC Musculoskelet Disord. 2021 1;22(1):318. doi:10.1186/s12891-021-04195-8.
  22. Jochimsen KN, Kramer E, Van Wyngaarden J, Noehren B, Samaan MA, Duncan ST, et al. Preoperative Temporal Summation is Associated with Impaired Recovery Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome Arch Bone Jt Surg. 2024;12(8):580-6.doi:10.22038/abjs.2024.78368.3607.
  23. Haddaway NR, Grainger MJ, Gray CT. Citationchaser: A tool for transparent and efficient forward and backward citation chasing in systematic searching. Res Synth Methods. 2022;13(4):533-45. doi:10.1002/jrsm.1563.
  24. Seddigh S, Bishop A, Wong I. Arthroscopic Debridement of Intrapelvic Abscess with Coexistent Septic Hip in an Adult Female: A Technical Note. Arthrosc Sports Med Rehabil. 2020;2(6):e909-e15. doi:10.1016/j.asmr.2020.06.015.
  25. Bould M, Edwards D, Villar RN. Arthroscopic diagnosis and treatment of septic arthritis of the hip joint. Arthroscopy. 1993;9(6):707-8.doi:10.1016/s0749-8063(05)80513-4.
  26. Kim JT, Kim HY, Kim CH, Park JI, Aditya K, Kim HY, Yoon PW. Arthroscopic resection arthroplasty for septic hip with osteonecrosis of the femoral head in patients with multiple comorbidities: A report of two cases. J Orthop Sci. 2021;26(1):186-9. doi:10.1016/j.jos.2018.05.012.
  27. Yamamoto Y, Ide T, Hachisuka N, Maekawa S, Akamatsu N. Arthroscopic surgery for septic arthritis of the hip joint in 4 adults. Arthroscopy. 2001;17(3):290-7.doi:10.1053/jars.2001.20664.
  28. Yoon PW, Song JH, Yoon KS, Chang JS, Kim HJ, Rhyu KH. Aspergillus Septic Arthritis of the Hip in an Immunocompetent Middle-aged Female with Undiagnosed Recurrent Pulmonary Aspergillosis. Hip Pelvis. 2015;27(3):196-200. doi:10.5371/hp.2015.27.3.196.
  29. Mansour E, El-Masri F. Bilateral Salmonella Septic Arthritis of the Hip in a Patient with Crohn Disease: A Case Report. JBJS Case Connect. 2016; 6(4):e91.doi:10.2106/jbjs.Cc.16.00045.
  30. Haviv B, Thein R, Burg A, Heller S, Bronak S, Velkes S. Chondrolysis of the Hip following Septic Arthritis: A Rare Complication of Magnetic Resonance Arthrography. Case Rep Orthop. 2013; 2013:840681. doi:10.1155/2013/840681.
  31. Gowda AL, Mease SJ, Dhar Y. Eikenella corrodens septic hip arthritis in a healthy adult treated with arthroscopic irrigation and debridement. Am J Orthop (Belle Mead NJ). 2014;43(9):419-21.
  32. Jan N, Pietrzak J, Baudoux M, Kaba A. Pediatric septic arthritis of the hip: The benefit of hip arthroscopy by extracapsular (outside-in) approach. Orthopaedic Journal of Sports Medicine. 2020;8(2).doi:10.1177/2325967120S00011.
  33. Walinga AB, Struijs PAA, de Waard S, Kerkhoffs GMMJ, Kievit AJ. Needle arthroscopy in the treatment of bacterial arthritis of the hip in a neonate and two infants. Journal of Pediatric Surgery Case Reports. 2022;87.doi:10.1016/j.epsc.2022.102470.
  34. Wong TM, Lou N, Jin W, Leung F, To M, Leung F. Septic arthritis caused by Brucella melitensis in urban Shenzhen, China: a case report. J Med Case Rep. 2014 14;8:367. doi:10.1186/1752-1947-8-367.
  35. Matsuda DK, Calipusan CP. Emergent hip arthroscopy: life-saving intervention for septic hip and secondary multiorgan failure. Orthopedics. 2012 1;35(7):e1090-3.doi:10.3928/01477447-20120621-28.
  36. Kim SJ, Choi NH, Kim HJ. Operative hip arthroscopy. Clin Orthop Relat Res. 1998 (353):156-65.doi:10.1097/00003086-199808000-00018.
  37. Blitzer CM. Arthroscopic management of septic arthritis of the hip. Arthroscopy. 1993;9(4):414-6.doi:10.1016/s0749-8063(05)80315-9.
  38. Schröder JH, Krüger D, Perka C, Hufeland M. Arthroscopic Treatment for Primary Septic Arthritis of the Hip in Adults. Adv Orthop. 2016; 2016:8713037. doi:10.1155/2016/8713037.
  39. Kim CH, Aditya K, Lee SJ, Kim HJ, Yoon KS, Kim HJ, Yoon PW. Arthroscopic treatment of psoas abscess concurrent with septic arthritis of the hip joint. Hip Int. 2018;28(3):336-40. doi:10.5301/hipint.5000579.
  40. Nusem I, Jabur MK, Playford EG. Arthroscopic treatment of septic arthritis of the hip. Arthroscopy. 2006;22(8):902.e1-3.doi:10.1016/j.arthro.2005.12.057.
  41. Sanpera I, Raluy-Collado D, Sanpera-Iglesias J. Arthroscopy for hip septic arthritis in children. Orthop Traumatol Surg Res. 2016; 102(1):87-9. doi:10.1016/j.otsr.2015.10.008.
  42. Danilov C, Fernandez FF, Wirth T, Eberhardt O. Relevant factors in the diagnosis of concomitant osteomyelitis in pediatric hip septic arthritis. A series of 41 cases treated by hip arthroscopy. Arch Orthop Trauma Surg. 2023;143(4):1825-32. doi:10.1007/s00402-022-04371-y.
  43. Eberhardt O, Wirth T, Fernandez FF. Hip Arthroscopy in Children under the Age of Ten. Open Journal of Orthopedics. 2013 2013;3(1):41-8.doi:doi:10.4236/ojo.2013.31009.
  44. Chung WK, Slater GL, Bates EH. Treatment of septic arthritis of the hip by arthroscopic lavage. J Pediatr Orthop. 1993; 13(4):444-6.doi:10.1097/01241398-199307000-00005.
  45. El-Sayed AM. Treatment of early septic arthritis of the hip in children: comparison of results of open arthrotomy versus arthroscopic drainage. J Child Orthop. 2008;2(3):229-37. doi:10.1007/s11832-008-0094-0.
  46. Edmonds EW, Lin C, Farnsworth CL, Bomar JD, Upasani VV. A Medial Portal for Hip Arthroscopy in Children With Septic Arthritis: A Safety Study. J Pediatr Orthop. 2018; 38(10):527-31.doi:10.1097/bpo.0000000000000861.
  47. Garg R, Ho J, Gourineni PV. Simplified arthroscopic lavage of pediatric septic hip: case series. J Pediatr Orthop B. 2020; 29(3):304-8.doi:10.1097/bpb.0000000000000717.
  48. Tiwari V, Khan SA, Kumar A, Poudel R, Kumar VS. Functional improvement after hip arthroscopy in cases of active paediatric hip joint tuberculosis: a retrospective comparative study vis-à-vis conservative management. J Child Orthop. 2015; 9(6):495-503. doi:10.1007/s11832-015-0705-5.
  49. Zhou P, Li S, Zhao M, Shao H, Zhang P. Clinical efficacy of arthroscopy combined with irrigation and drainage in the treatment of brucellosis of the hip. Int Orthop. 2023;47(11):2751-6. doi:10.1007/s00264-023-05926-3.
  50. Kamiński A, Muhr G, Kutscha-Lissberg F. Modified open arthroscopy in the treatment of septic arthritis of the hip. Ortop Traumatol Rehabil. 2007;9(6):599-603.
  51. Khazi ZM, Cates WT, An Q, Duchman KR, Wolf BR, Westermann RW. Arthroscopy Versus Open Arthrotomy for Treatment of Native Hip Septic Arthritis: An Analysis of 30-Day Complications. Arthroscopy. 2020; 36(4):1048-52. doi:10.1016/j.arthro.2019.10.008.
  52. Kalantar SH, Hoveidaei AH, Bagheri N, Khabiri SS, Poursalehian M. Marginal bone resection and immediate internal fixation in multidrug resistant chronic septic nonunions of lower limb long bones: a case series. Int Orthop. 2024 21. doi:10.1007/s00264-024-06349-4.
  53. Tuncay I, Ucan V, Agir M, Anwar W, Elmali N. Is Only Peripheral Hip Arthroscopy Enough for Selected Patients with Femoroacetabular Impingement Syndrome? Arch Bone Jt Surg. 2022; 10(12):1044-8.doi:10.22038/abjs.2022.53954.2698.
  54. Bitar AC, Guimarães JB, Marques R, de Castro Trindade CA, Filho AGO, Nico MAC, de Amorim Cabrita HAB. Clinical and Radiological Results after Endoscopic Treatment for Gluteal Tendon Injuries with a Minimum Follow-Up of 12 Months. Arch Bone Jt Surg. 2023; 11(10):641-8.doi:10.22038/abjs.2023.70495.3304.
  55. Hyman JL, Salvati EA, Laurencin CT, Rogers DE, Maynard M, Brause DB. The arthroscopic drainage, irrigation, and débridement of late, acute total hip arthroplasty infections: average 6-year follow-up. J Arthroplasty. 1999; 14(8):903-10.doi:10.1016/s0883-5403 (99)90001-3.
  56. McCarthy J, Jibodh S, Lee J-A. The Role of Arthroscopy in Evaluation of Painful Hip Arthroplasty. Clinical orthopaedics and related research. 2008 11/01;467:174-80.doi:10.1007/s11999-008-0525-8.
  57. Schwarz EM, Parvizi J, Gehrke T, Aiyer A, Battenberg A, Brown SA, et al. 2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions. J Orthop Res. 2019;37(5):997-1006. doi:10.1002/jor.24293.
  58. Poursalehian M, Zafarmandi S, Razzaghof M, Mortazavi SMJ. The impact of retaining the femoral stem in revision total hip arthroplasty: a systematic review, meta-analysis, and meta-regression. Arch Orthop Trauma Surg. 2024;144(2):947-66. doi:10.1007/s00402-023-05087-3.
  59. Ellis HB, Copley L, Pennock A, Nepple JJ, Willimon C, Mayer SW, Yen YM. Tractionless Hip Arthroscopy for Septic Arthritis in Children. Arthrosc Tech. 2021;10(3):e659-e67. doi:10.1016/j.eats.2020.10.079.
  60. Poursalehian M, Hassanzadeh A, Lotfi M, Mortazavi SMJ. Conversion of a Failed Hip Hemiarthroplasty to Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. Arthroplast Today. 2024;28:101459. doi:10.1016/j.artd.2024.101459.

 

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 2
February 2025
Pages 62-74

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History

  • Receive Date: 16 June 2024
  • Revise Date: 03 November 2024
  • Accept Date: 04 November 2024

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