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Stage-based arthroscopic treatment safely controls adult hip septic arthritis and significantly improves pain and hip function, with the best outcomes seen in early disease stages.
Hip septic arthritis (SA) remains a rare yet devastating orthopedic emergency that rapidly compromises articular cartilage and can progress to osteonecrosis, osteomyelitis, and life-threatening systemic infection. Hence, researchers conducted a retrospective study to determine the surgical safety and clinical efficacy of arthroscopic management while optimizing the treatment strategy through stage-specific and intraoperative finding–guided interventions.
They analyzed 28 adult patients with hip SA, including 18 females and 10 males with a mean age of 49 ± 10.5 years. Diagnosis was confirmed through synovial fluid analysis, microbial cultures, or synovial pathology. All patients underwent arthroscopic joint lavage, synovectomy, and drainage, with procedures customized based on intraoperative findings and Gächter staging. Antibiotic therapy was administered according to culture sensitivity results or empirically when cultures were negative.
Clinical symptoms, comorbidities, inflammatory markers, microbiological findings, antibiotic duration, complications, and long-term outcomes were systematically recorded and analyzed, with a minimum follow-up of 3 years. The mean duration from first symptoms to definitive surgical procedure was 10.2 ± 8.6 days (range, 4–45 days). Elevated inflammatory markers were observed in all patients preoperatively. Bacterial cultures were positive in 6 patients preoperatively and in 21 patients postoperatively.
Infection control was achieved in all patients within 6 months. Two patients with Gächter stage III or IV disease experienced recurrence at 8 and 11 months, both successfully managed with repeat arthroscopy. Advanced Gächter stage (III–IV) was identified as a risk factor for recurrence. Two patients progressed to total hip arthroplasty due to secondary osteoarthritis and osteonecrosis with no major surgical complications.
Overall, a stage-adapted arthroscopic approach combining lavage, synovectomy, drainage, and targeted antibiotic therapy effectively controlled infection and restored hip function in adult patients with SA. Early-stage disease responded particularly well, achieving durable infection resolution and significant functional improvement. In contrast, advanced-stage infections required closer surveillance due to an elevated risk of recurrence.
Orthopaedic Surgery
Arthroscopic Management for Hip Joint Septic Arthritis: A Retrospective Study of 28 Adult Patients With a Minimum 3-Year Follow-Up
Shu Chen et al.
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