Donders CM, Spaans AJ, van Wering H, van Bergen CJ. Developments in diagnosis and treatment of paediatric septic arthritis. World J Orthop 2022; 13(2): 122-130 [PMID: 35317401 DOI: 10.5312/wjo.v13.i2.122]
Corresponding Author of This Article
Cornelia M Donders, MD, MSc, Academic Research, Department of Orthopaedic Surgery, Meander Medical Centre, Maatweg 3, Amersfoort 3813 TZ, Netherlands. lilian.donders@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Feb 18, 2022; 13(2): 122-130 Published online Feb 18, 2022. doi: 10.5312/wjo.v13.i2.122
Developments in diagnosis and treatment of paediatric septic arthritis
Cornelia M Donders, Anne J Spaans, Herbert van Wering, Christiaan JA van Bergen
Cornelia M Donders, Department of Orthopaedic Surgery, Meander Medical Centre, Amersfoort 3813 TZ, Netherlands
Anne J Spaans, Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen 6574 NA, Netherlands
Herbert van Wering, Department of Paediatrics, Amphia Hospital, Breda 4818 CK, Netherlands
Christiaan JA van Bergen, Department of Orthopedic Surgery, Amphia Hospital, Breda 4818 CK, Netherlands
Author contributions: Donders CM contributed to the conceptualization; study-selection; data extraction; data analysis; writing of the manuscript; Spaans AJ and van Wering H critically revised the manuscript; van Bergen CJ contributed to the conceptualization; supervision; writing of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cornelia M Donders, MD, MSc, Academic Research, Department of Orthopaedic Surgery, Meander Medical Centre, Maatweg 3, Amersfoort 3813 TZ, Netherlands. lilian.donders@gmail.com
Received: February 26, 2021 Peer-review started: February 26, 2021 First decision: July 28, 2021 Revised: August 8, 2021 Accepted: January 20, 2022 Article in press: January 20, 2022 Published online: February 18, 2022 Processing time: 356 Days and 10.2 Hours
Abstract
Acute septic arthritis in children is an orthopaedic emergency. A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence. The clinical presentation can be a diagnostic challenge, especially in young children. A recent systematic review showed that joint tenderness and fever are important signals of septic arthritis. Ultrasound is helpful in detecting the presence of a joint effusion. Plain radiographs may show bone changes but magnetic resonance imaging is the most reliable imaging study for detecting concomitant osteomyelitis. The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint, in case of a positive culture or a positive gram stain of the joint fluid, or if there is a white blood-cell count in the joint fluid of more than 50000/mm3. Staphylococcus aureus is the most commonly cultured organism. Recent systematic reviews have identified the most effective drainage techniques, including needle aspiration, arthroscopy and arthrotomy, depending on the affected joint. After the drainage procedure it is important to monitor the clinical and laboratory outcomes. Additional drainage procedures may be necessary in select cases.
Core Tip: This article provides an up-to-date evidence-based review on the diagnosis and treatment of paediatric septic arthritis. Acute septic arthritis in children is an orthopaedic emergency. It can be a diagnostic challenge, especially in young children. Accurate history, physical exam, laboratory findings and imaging can contribute to the diagnosis of septic arthritis. The following step of joint aspiration with an appropriate treatment must be made in a short time period. Clinical predicting tools and optimal drainage techniques for paediatric septic arthritis were evaluated in recent systematic reviews. After the drainage procedure it is important to monitor the clinical and laboratory outcomes.
