Arthroscopic treatment of psoas abscess concurrent with septic arthritis of the hip joint

2017 ◽  
Vol 28 (3) ◽  
pp. 336-340 ◽  
Author(s):  
Chul-Ho Kim ◽  
Kekatpure Aditya ◽  
Soong-Joon Lee ◽  
Hyo-June Kim ◽  
Kang-Sup Yoon ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Psoas Abscess ◽  
Positive Culture ◽  
Peripheral Compartment ◽  
Drain Tube ◽  
Arthroscopic Debridement ◽  
Suction Drain ◽  
Anterior Capsulotomy

Purpose: To describe the outcomes of 7 cases of psoas abscess concurrent with septic arthritis of the hip treated by hip arthroscopy alone. Methods: We retrospectively collected the data of patients who underwent arthroscopic drainage of psoas abscess concurrent with septic arthritis of the hip. Arthroscopic debridement was performed in both the central and peripheral hip joint compartments. In all cases, the iliopsoas compartment was accessed from the peripheral compartment through an anterior capsulotomy without limb traction. After debridement and drainage of the iliopsoas compartment, a suction drain tube was placed in the iliopsoas compartment through an enlarged anterior capsulotomy and another tube in the peripheral compartment. Postoperative intravenous antibiotics were administered on the basis of culture results; in cases with no positive culture, empirical antibiotics were administered for 4 to 6 weeks after surgery. Results: 7 patients underwent arthroscopic debridement and drainage for a psoas abscess concurrent with hip joint septic arthritis. Laboratory tests were normalized within 4 weeks after hip arthroscopy in all patients. At a median follow-up of 16 months (range, 13-30 months) after surgery, infection recurrence was absent in all patients. Conclusions: Arthroscopic debridement alone could be an effective treatment alternative to open surgery for psoas abscess concurrent with hip joint septic arthritis.

scholarly journals Pediatric septic arthritis of the hip: the benefit of hip arthroscopy by extracapsular (outside-in) approach

2020 ◽  
Vol 8 (2_suppl) ◽  
pp. 2325967120S0001
Author(s):  
Nicolas Jan ◽  
Julien Pietrzak ◽  
Matthieu Baudoux ◽  
Arnaud Kaba
Keyword(s):  
Septic Arthritis ◽  
Hip Arthroscopy ◽  
Weight Bearing ◽  
Needle Aspiration ◽  
High Rate ◽  
Peripheral Compartment ◽  
X Rays ◽  
Quick Method ◽  
Emergency Situations ◽  
Tensor Fasciae Latae

Background: Pediatric septic arthritis of the hip is a surgical emergency. Facing a hip flexum and fever, surgeons can use comparative ultrasound to confirm the diagnosis and to establish the surgical indication. While needle aspiration-irrigation is a simple and quick method, it gives rise to a high rate of recurrence. The purpose of our study was to demonstrate that hip arthroscopy by extracapsular approach is an effective and accessible alternative applicable in emergency situations. Methods: This is a report of 2 cases (7 years-135 cm; 13 years-143 cm) of needle aspiration-irrigation failure subsequently treated by hip arthroscopy. The X-ray and arthroscopy-assisted extracapsular technique was performed on a conventional orthopedic table, using a 30 degree arthroscope and a 3.5mm diameter motorized knife. Minimally invasive anterior longitudinal capsulotomy was performed by 2 anterolateral approaches via the proximal and distal tensor Fasciae Latae muscle, without dedicated instrumentation, followed by sampling, irrigation, removal of false membranes, synovial biopsies, partial synovectomy, cartilage assessment of the central then peripheral compartment and placement of a drainage. Results: In both cases, effusion completely disappeared and the inflammatory process gradually normalized with antibiotic therapy without any repeat procedure or complications related to the approach. Weight bearing was resumed in 3 weeks. Postoperatively, in 6 months and 15 months respectively, after resumption of sports activities hip examination was painless and no damage was noted on x-rays in either case. Conclusion: In our experience, hip arthroscopy by extracapsular approach can effectively address cases of failed needle aspiration-irrigation in pediatric septic arthritis of the hip. It could be provided as first-line emergency treatment in the event of purulent septic arthritis or late management, as a replacement for arthrotomy.

scholarly journals Portal enlargement in hip arthroscopy preserving the iliofemoral ligament: a novel access technique protecting soft tissue restraints

2020 ◽  
Vol 7 (2) ◽  
pp. 313-321 ◽  
Author(s):  
Victor M Ilizaliturri ◽  
Ruben Arriaga Sánchez ◽  
Rafael Zepeda Mora ◽  
Carlos Suarez-Ahedo
Keyword(s):  
Soft Tissue ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Central Compartment ◽  
Peripheral Compartment ◽  
Hip Instability ◽  
Hip Stability ◽  
Relevant Role ◽  
Iliofemoral Ligament

Abstract Capsulotomy in different modalities has been used to provide adequate exposure to access both the central and peripheral compartment in hip arthroscopy. Even though the hip joint has inherent bony stability, soft tissue restraints may be important in patients with ligaments hyperlaxity or in some cases with diminished bony stability. Biomechanical studies and clinical outcomes have shown the relevant role of the capsule in hip stability, mainly the role of the iliofemoral ligament. Although is not very common, iatrogenic post-arthroscopy subluxation and dislocation have been reported and many surgeons are concerned about the role aggressive capsulotomy or capsulectomy in this situation, thus capsule repair has become very popular. We present a novel technique to access the hip without cutting the iliofemoral ligament. With this technique we can obtain adequate arthroscopic access to the hip joint in order to treat adequately the central compartment pathologies reducing the risk of iatrogenic post-operative hip instability.

scholarly journals The Role of Hip Arthroscopy in the Management of Acute Arthritis of Hip

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0011
Author(s):  
Sheung Tung Ho ◽  
Hoi Yeung Ip ◽  
Ming Yu Chiu ◽  
Sze Hung Wong
Keyword(s):  
Septic Arthritis ◽  
Hip Arthroscopy ◽  
Vastus Lateralis ◽  
Positive Culture ◽  
Good Alternative ◽  
Postoperative Recovery ◽  
Hip Pain ◽  
Joint Fluid ◽  
Delayed Treatment ◽  
Hip Arthritis

Septic arthritis of hip is an orthopaedic emergency requiring early diagnosis and prompt surgical treatment to avoid grave complications like avascular necrosis and chondrolysis and post-infectious arthrosis. This is a retrospective review of 9 patients who underwent hip arthroscopy for suspected septic arthritis of hip from 2012 to 2018. Medical charts were reviewed to determine the efficacy of the use of hip arthroscopy in the diagnosis and treatment of acute hip arthritis. The age of patients ranged from 9 to 82. The mean follow-up was 29 months (1 to 49). All presented with hip pain and effusion in imaging by CT scan or ultrasonography. Fever was present in 5 out of 9 patients. Hip arthroscopy with 2 portals technique and joint lavage +/- debridement was done. Two patients had whitish suspension in the joint fluid and pathology confirmed pseudogout of hip. The remaining 7 patients were diagnosed and treated as septic hip arthritis. Only 3 had positive culture, probably related to the prior use of antibiotics. All except one responds well to arthroscopic debridement and lavage with infection eradicated, good hip motion and hip function. One patient of delayed treatment (2 weeks after onset of hip pain) had ongoing infection, requiring further arthrotomy and Girdlestone operation for uncontrolled hip infection with intramuscular abscess of vastus lateralis. Hip arthroscopy is a useful diagnostic tool in acute hip arthritis. Besides septic arthritis, monoarticular attack of psuedogout is an important differential diagnosis of acute hip pain in elderly. Early hip arthroscopy can result in rapid postoperative recovery. Arthroscopic lavage and debridement is safe and a good alternative to open arthrotomy in hip septic arthritis.

A CT-free protocol to treat osteoid osteoma of the hip region in childhood and adolescence by percutaneous drilling and by hip arthroscopy

2021 ◽  
pp. 112070002199626
Author(s):  
Oliver Eberhardt ◽  
Thekla von Kalle ◽  
Rebecca Matthis ◽  
Richard Doepner ◽  
Thomas Wirth ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Standard Form ◽  
Childhood And Adolescence ◽  
Ct Guided ◽  
Contrast Enhanced ◽  
Mri Guided ◽  
Mri Diagnostics

Introduction: It is often difficult to clinically and radiologically diagnose intra-articular osteoid osteomas and osteoid osteomas of the hip joint. Treatment can also be difficult due to complex locational relationships. CT-guided radiofrequency ablation is currently the standard form of treatment. In this paper we report on a minimally-invasive concept for treating osteoid osteomas near the hip joint in children and adolescents which does not involve using computed tomography. Material and method: 10 patients with an average age of 12.1 years underwent treatment for osteoid osteomas in the hip joint region. The diagnosis was made using a contrast-enhanced MRI. The osteoid osteomas were marked percutaneously using x-ray and MRI guidance. MRI-guided drilling/curettage was performed in 4 cases and arthroscopic resection in 6 cases. Results: All lesions were successfully treated using the MRI-guided method. All patients were free of pain after the treatment. There was no instance of recurrence during the follow-up period, which averaged 10 months. The effective dose for marking the lesion was between 0.0186 mSv and 0.342 mSV (mean 0.084 mSV). Conclusions: Our MRI diagnostics protocol, the MRI-guided drilling and the minimally invasive hip arthroscopy represent an alternative to CT-guided radiofrequency ablation in the treatment of osteoid osteomas. Radiation exposure can thereby be significantly reduced. Hip arthroscopy can also be used to treat secondary pathologies such as femoroacetabular impingement.

Iliacus pyomyositis mimicking septic arthritis of the hip joint

1996 ◽  
Vol 115 (3-4) ◽  
pp. 233-235 ◽  
Author(s):  
W. -S. Chen ◽  
Y. -L. Wan
Keyword(s):  
Septic Arthritis ◽  
Hip Joint

scholarly journals Postless Hip Arthroscopy: A Safer Alternative for Treatment of Femoracetabular Impingement Syndrome

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110067
Author(s):  
Michael B. Held ◽  
Liana J. Tedesco ◽  
Mario H. Lobao ◽  
T. Sean Lynch
Keyword(s):  
Hip Joint ◽  
Hip Arthroscopy ◽  
Pudendal Nerve ◽  
Patient Positioning ◽  
Central Compartment ◽  
Operating Table ◽  
Complication Rates ◽  
Iatrogenic Complications ◽  
Diagnostic Arthroscopy ◽  
Hip Distraction

Background: Hip arthroscopy for femoroacetabular impingement (FAI) syndrome continues to gain popularity and indications for its use are expanding. Though low complication rates have previously been reported, there are iatrogenic complications specific to the use of the perineal post, such as pudendal nerve injuries, and possible pressure skin necrosis that warrant concern in the healthy young patient. The risk of these complications are increased during simultaneous bilateral hip arthroscopy. Indications: We describe a new technique, which will prevent such problems by using a postless pink pad technique in order to achieve adequate hip distraction. Technique Description: Arthroscopic investigation begins with proper, safe patient positioning in order to gain access to the hip joint with sufficient joint distraction. In the postless technique, a dense foam pad is utilized in lieu of a perineal post. The static friction between the pad, bed, and the patient counters the manual gross traction necessary to distract the hip joint while preventing the patient from sliding down or off of the operating table. The postless technique avoids pressure to the perineum and also allows for greater range of motion during dynamic intraoperative examination and femoroplasty. After hip distraction, standard portal placement allows for access to the central compartment in order to assess intraarticular pathology. Once identified on diagnostic arthroscopy, appropriate techniques are utilized to correct acetabular-sided pincer lesions, labral tears, and femoral-sided cam deformities. Results: When discussing this technique with patients, it is important to highlight that it diminishes the possibility of iatrogenic pressure injury to the pudendal nerve and skin of the perineum. The risk of these injuries typically occurs when the pudenal nerve is compressed against the post during traction and abduction. As such, postless technique prevents any compression and pressure to these regions. Discussion/Conclusion: Hip arthroscopy is a minimally invasive, low morbidity technique for treating a variety of chondral, ligamentous, and bony conditions of the hip. However, studies suggest that pudenal nerve injury is seen in up to 4.3% of patients following hip arthroscopy. Given avoidance of iatrogenic post complications, we describe a postless technique for achieving hip distraction during hip arthroscopy.

MRI in Suspected Acute Septic Arthritis of the Hip Joint in Children

Hip & Pelvis ◽  
2012 ◽  
Vol 24 (4) ◽  
pp. 295 ◽  
Author(s):  
Soo-Sung Park ◽  
Soo-Ho Lee ◽  
Gyeong-Bo Sim
Keyword(s):  
Septic Arthritis ◽  
Hip Joint
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