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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 commonly managed via hip arthrotomy and lavage. Arthroscopic lavage is a less invasive alternative that is associated with low surgical morbidity, effective joint lavage, and decreased hospital length of stay. This video describes a simplified technique for single portal arthroscopic lavage of the pediatric hip, which can be performed by a general orthopaedic surgeon without fellowship training in hip arthroscopy. Methods/Results: This video demonstrates a simplified technique for single portal arthroscopic lavage of the pediatric hip. The method involves the use of a single portal based solely on surface anatomic landmarks and can be performed without traction. The limited equipment required and the ease of landmark identification with this technique broadens the application to general orthopaedic surgeons and limits the risk of iatrogenic complications. In addition, the video reviews outcomes from our case series of 13 pediatric septic hips managed via the single portal technique. The video also reviews data from a novel model developed to simulate single versus multiple portal lavage. Discussion and Conclusion: Septic arthritis is an orthopaedic emergency requiring urgent surgical management. In the knee and shoulder, arthroscopic lavage has replaced arthrotomy as the preferred treatment technique. However, in the septic hip, unfamiliarity with hip arthroscopy instruments, positioning, and equipment setup has precluded the widespread adoption of arthroscopic lavage. Previous studies have described techniques involving the use of two or three arthroscopic portals on a traction table. These methods are considered technically demanding and their use is limited to experienced hip arthroscopists. Our single portal method is a simplified yet effective technique for the management of the pediatric septic hip. The use of hip arthroscopy continues to increase among orthopaedic surgeons. A simplified technique for effective lavage enables general orthopaedic surgeons to implement an arthroscopic approach to the septic hip, thereby avoiding arthrotomy.

Results for "Hip and Pelvis"

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