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Single Portal Hip Arthroscopy for Septic Arthritis in the Pediatric Patient

February 19, 2016

Contributors: Rohit Garg, MD; David Savin, MD; Brian Edward Schwartz, MD; Prasad V Gourineni, MD; Peter McQueen, MD; Peter McQueen, MD

INTRODUCTION: Septic arthritis of the pediatric hip is a surgical emergency for which hip arthrotomy and lavage is commonly performed. Arthroscopic lavage is a less invasive alternative that offers low surgical morbidity, effective joint lavage, and reduced hospital stay. In this video, we describe a simplified technique for single portal arthroscopic lavage of the pediatric hip that can be performed by the general orthopaedist without fellowship training in hip arthroscopy.

METHODS/RESULTS: Utilizing digital media, including live intraoperative footage, we present a simplified technique for single portal arthroscopic lavage of the pediatric hip. This method utilizes a single portal based solely on surface anatomical landmarks and can be performed without the use of traction. The limited equipment required and the ease of landmark identification with the demonstrated technique broadens the application to the general orthopaedist and limits the chance of iatrogenic complications. In addition, we present outcomes from our case series of 13 pediatric septic hips treated using the single portal technique. We also review data from a novel model developed to simulate single vs. multiple portal lavage.

DISCUSSION AND CONCLUSION: Septic arthritis is an orthopaedic emergency requiring urgent surgical intervention. In the knee and shoulder, arthroscopic lavage has replaced arthrotomy as the favored technique. In the septic hip, however, unfamiliarity with hip arthroscopy instruments, positioning, and equipment setup has precluded the widespread utilization of arthroscopic lavage. Previous reports have described techniques using two or three arthroscopic portals on a traction table. These methods have been considered technically demanding and their use has been limited to the purview of experienced hip arthroscopists. Our single portal method provides a simplified yet effective technique for the treatment of the pediatric septic hip. The utilization of hip arthroscopy continues to grow among orthopaedists. A simplified technique for effective lavage enables the general orthopaedist to implement an arthroscopic approach to the septic hip, therefore avoiding arthrotomies in these patients.

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