X-ref For other Roundups in this issue that cross-reference with Children’s orthopaedics see: Oncology Roundup 8.
Arthroscopy suitable in young children
Historically, the standard of care for treatment of septic arthritis in the child has been an open washout with joints as diverse as ankles, hips, knees and elbows all being treated in a remarkably similar way. Hot on the heels of a paper in last month’s 360 suggestive of successful treatment of septic arthritis in the paediatric hip arthroscopically, comes this clinical paper from paediatric surgeons in Oak Lawn, Illinois (USA) which presents a single-surgeon series of paediatric large-joint septic arthritis managed arthroscopically.1 The authors present the clinical results of 24 children aged between three weeks and six years, all treated for septic arthritis of large joints. There was a mix of hip, knee, ankle and shoulder, all treated successfully with just a single femoral nerve palsy. This retrospective cohort study assessed the use of arthroscopic lavage in 24 children over a four-year period. Nine hips, nine knees, four ankles and two shoulders were treated in patients aged between three weeks and six years. Patients were assessed between two and 49 months (mean 16 months) after the index procedure and there was no recurrence of infection or decreased range of motion. Two patients required repeat arthroscopic lavage and one patient required open irrigation following arthroscopic lavage. There was one transient femoral nerve palsy but no other arthroscopy-associated complications. Arthroscopy offers some well known advantages over open surgery, but is not a method of choice in treating this pathology in this age group. The authors argue that this might be due to the lack of arthroscopy training in paediatric orthopaedic fellowships. With no recurrence of infection at the 16-month follow-up, this really does make arthroscopy a viable option for treating septic arthritis of …