Risk factors for secondary surgical intervention following primary arthrotomy in children with presumed septic arthritis of the hip have been identified, according to data published in the Journal of the American Academy of Orthopaedic Surgeons.

Researchers retrospectively analyzed surgical data of 138 children from 3 major pediatric hospitals over the course of 10 years. They assessed various patient-specific factors, including clinical presentation, demographics, imaging and laboratory results, and infecting agent. Statistical regression techniques were used to calculate the risk of undergoing a subsequent surgical procedure.

After analysis, the investigators found that 41% of children in the cohort had a minimum of 1 repeat surgical intervention after initial arthrotomy for presumed septic arthritis of the hip. In addition, the researchers reported that having an erythrocyte sedimentation rate >40 on presentation (P =.011) and C-reactive protein level >10 mg/dL (P =.002) were independent risk factors for repeat surgical intervention. Risk for repeat surgical intervention was also increased by the presence of concomitant osteomyelitis (odds ratio, 3.4; P =.001).

Primary study limitations included the retrospective design and clinical evaluation by multiple surgeons.

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“If these factors can be validated prospectively, as has been proposed and validated for patients with presumed acute hematogenous osteomyelitis, they could have a role in clinical decision-making guidelines or algorithms,” the researchers wrote.

“Until then, physicians may wish to consider these data on a case-by-case basis, in conjunction with other clinical information, in cases of presumed pediatric [septic arthritis of the hip],” they concluded.

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Reference

Murphy RF, Plumblee L, Barfield WB, et al. Septic arthritis of the hip-risk factors associated with secondary surgery [published online December 4, 2018]. J Am Acad Orthop Surg. doi:10.5435/JAAOS-D-18-00058