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Athroscopic Washout Aids in Treatment for Septic Arthritis in Children
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Posted on: 09/11/2008
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Septic arthritis is a type of arthritis that is caused by an infection in a joint. The infection is usually caused by bacteria, but can be caused by a virus or fungus, as well. Septic arthritis can occur in children. In fact, three percent to four percent of all cases of this type of arthritis are in children. Because this type of arthritis can cause quite a bit of damage to the joint, early detection and treatment are vital.
In this article, the authors discuss the case of a six-year-old boy who complained of fever and pain in the right shoulder. The shoulder was painful but there had been no injury or trauma to the area. He was treated initially by doctors at a local hospital, who first gave the patient an antibiotic, amoxicillin, for five days. This was stopped, however, because there was no change in the boy's fever. The doctors then started treatment with two more antibiotics given by intravenous: teicoplanin, a strong antibiotic usually used for severe infections was given for 15 days and then meropenem followed for another 15 days.
After the 28 days of treatment, although the boy's fever had gone down a bit, the pain wasn't relieved and he was still unable to use his shoulder properly. At this point, the doctors did a arthrocentesis, where they removed some of the fluid in the joint to analyze it. Although the fluid was green-yellow, the analysis didn't find any particular cause for the infection.
By the time the boy was seen by the authors of this article, 35 days had passed from the first day of symptoms. The shoulder x-rays showed that there was fluid in the joint and that there was a thickening of tissue as well. The patient also had a computed tomography scan (CT scan) and magnetic resonance imaging (MRI), with which the doctors could see that the bone in the joint had been damaged. The results of these images and the fluid analysis helped the doctors diagnose septic arthritis.
Treatment for septic arthritis of the knee in children is usually an arthroscopic washout and it is being used more often for treatment of septic arthritis of the hip. However, it has rarely been done for septic arthritis of the shoulder. The procedure involves making a small incision in the joint and then flushing the joint with fluid. The authors of this article performed the washout and debrided the area as well, removing any debris or dead tissue in the joint. Lastly, they did a synoviectomy, which is removing some of the membrane. Drainage tubes were left in so more irrigation to the joint could be done and the arm was placed in a sling.
The drainage tubes were removed four days after the surgery. After receiving more antibiotics by intravenous, teicoplanin again and another antibiotic, ceftriaxone disodium, both for seven days after the surgery, the boy went home on oral antibiotics. He was seen at two months after the surgery and the doctors found that he had recovered completely, although the x-rays did show some irregularity in the bone.
The authors wrote that it isn't always easy to diagnose septic arthritis in children, which may delay treatment. The prognosis of a child with septic arthritis depends on the age of the child, how far the infection has gone, and how long the treatment has been delayed. Although aspirating the fluid with a needle is simple and inexpensive, this technique doesn't allow the doctor to see inside the joint nor to remove any debris if needed. Arthroscopic treatment, however, does allow for removing the fluid and performing other techniques as well.
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References:
Giovanni Luigi Di Gennaro, MD, et al. Arthroscopic Treatment of Septic Arthritis of the Shoulder in a 6-Year-Old Boy. In Orthopedics. Vol. 31:809.
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