Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection?
<p><strong>Background</strong>: Surgical management of septic arthritis (SA) of the hip aims at treating the infection by either preserving, resecting or replacing the joint. In some cases, joint preservation should be attempted, whereas other cases would benefit from immediate joi...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Copernicus Publications
2023-10-01
|
| Series: | Journal of Bone and Joint Infection |
| Online Access: | https://jbji.copernicus.org/articles/8/209/2023/jbji-8-209-2023.pdf |
| _version_ | 1797661283506454528 |
|---|---|
| author | F. Ruythooren F. Ruythooren S. Ghijselings S. Ghijselings J. Cools J. Cools M. Depypere P. De Munter P. De Munter W.-J. Metsemakers W.-J. Metsemakers G. Vles G. Vles |
| author_facet | F. Ruythooren F. Ruythooren S. Ghijselings S. Ghijselings J. Cools J. Cools M. Depypere P. De Munter P. De Munter W.-J. Metsemakers W.-J. Metsemakers G. Vles G. Vles |
| author_sort | F. Ruythooren |
| collection | DOAJ |
| description | <p><strong>Background</strong>: Surgical management of septic arthritis (SA) of the hip aims at
treating the infection by either preserving, resecting or replacing the
joint. In some cases, joint preservation should be attempted, whereas other cases would
benefit from immediate joint resection or replacement. Prognostic factors
have been proposed to guide decision-making. We hypothesized that most of
these factors can be simplified to three subgroups based on the route of
infection: contiguous spreading, direct inoculation or hematogenous
seeding. <strong>Methods</strong>: A total of 41 patients have been treated surgically for SA of the native
hip at our tertiary hospital during the last 16 years. Medical records were
studied, and various patient and disease characteristics were collated.
<strong>Results</strong>: Significant differences between (1) level of fitness, (2) condition of
the hip joint, (3) micro-organisms and (4) chance of femoral head
preservation were found for patients with SA of the native hip resulting
from the three aforementioned subgroups. Femoral head resection was necessary at one point
in 85 % of patients. Patients with hematogenous infections of undamaged
hips had a reasonable chance (53 %) of avoiding joint resection or
replacement. Hip arthroplasty was performed on 46.3 % of patients, with an
infection rate of 10.5 %. <strong>Conclusion</strong>: Patients with SA of the native hip
resulting from contiguous spreading, hematogenous seeding or direct
inoculation differ significantly and should be considered distinct clinical
entities. Route of infection is directly related to the chance of femoral
head preservation and should, therefore, guide decision-making. Only patients
with hematogenous infection to a previously healthy hip had the possibility of
femoral head preservation.</p> |
| first_indexed | 2024-03-11T18:42:12Z |
| format | Article |
| id | doaj.art-e201d1d9b51e42ad981c6e39caf47b29 |
| institution | Directory Open Access Journal |
| issn | 2206-3552 |
| language | English |
| last_indexed | 2024-03-11T18:42:12Z |
| publishDate | 2023-10-01 |
| publisher | Copernicus Publications |
| record_format | Article |
| series | Journal of Bone and Joint Infection |
| spelling | doaj.art-e201d1d9b51e42ad981c6e39caf47b292023-10-12T11:56:31ZengCopernicus PublicationsJournal of Bone and Joint Infection2206-35522023-10-01820921810.5194/jbji-8-209-2023Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection?F. Ruythooren0F. Ruythooren1S. Ghijselings2S. Ghijselings3J. Cools4J. Cools5M. Depypere6P. De Munter7P. De Munter8W.-J. Metsemakers9W.-J. Metsemakers10G. Vles11G. Vles12Department of Orthopaedic Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, BelgiumInstitute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, BelgiumDepartment of Orthopaedic Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, BelgiumInstitute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, BelgiumDepartment of Orthopaedic Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, BelgiumInstitute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, BelgiumDepartment of Laboratory Medicine, University Hospitals Leuven – Gasthuisberg, Leuven, BelgiumDepartment of General Internal Medicine, University Hospitals Leuven – Gasthuisberg, Leuven, BelgiumDepartment of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, BelgiumDepartment of Traumatology, University Hospitals Leuven – Gasthuisberg, BelgiumDepartment of Development and Regeneration, KU Leuven, Leuven, BelgiumDepartment of Orthopaedic Surgery, University Hospitals Leuven – Gasthuisberg, Leuven, BelgiumInstitute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium<p><strong>Background</strong>: Surgical management of septic arthritis (SA) of the hip aims at treating the infection by either preserving, resecting or replacing the joint. In some cases, joint preservation should be attempted, whereas other cases would benefit from immediate joint resection or replacement. Prognostic factors have been proposed to guide decision-making. We hypothesized that most of these factors can be simplified to three subgroups based on the route of infection: contiguous spreading, direct inoculation or hematogenous seeding. <strong>Methods</strong>: A total of 41 patients have been treated surgically for SA of the native hip at our tertiary hospital during the last 16 years. Medical records were studied, and various patient and disease characteristics were collated. <strong>Results</strong>: Significant differences between (1) level of fitness, (2) condition of the hip joint, (3) micro-organisms and (4) chance of femoral head preservation were found for patients with SA of the native hip resulting from the three aforementioned subgroups. Femoral head resection was necessary at one point in 85 % of patients. Patients with hematogenous infections of undamaged hips had a reasonable chance (53 %) of avoiding joint resection or replacement. Hip arthroplasty was performed on 46.3 % of patients, with an infection rate of 10.5 %. <strong>Conclusion</strong>: Patients with SA of the native hip resulting from contiguous spreading, hematogenous seeding or direct inoculation differ significantly and should be considered distinct clinical entities. Route of infection is directly related to the chance of femoral head preservation and should, therefore, guide decision-making. Only patients with hematogenous infection to a previously healthy hip had the possibility of femoral head preservation.</p>https://jbji.copernicus.org/articles/8/209/2023/jbji-8-209-2023.pdf |
| spellingShingle | F. Ruythooren F. Ruythooren S. Ghijselings S. Ghijselings J. Cools J. Cools M. Depypere P. De Munter P. De Munter W.-J. Metsemakers W.-J. Metsemakers G. Vles G. Vles Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? Journal of Bone and Joint Infection |
| title | Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? |
| title_full | Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? |
| title_fullStr | Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? |
| title_full_unstemmed | Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? |
| title_short | Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? |
| title_sort | should treatment decisions in septic arthritis of the native hip joint be based on the route of infection |
| url | https://jbji.copernicus.org/articles/8/209/2023/jbji-8-209-2023.pdf |
| work_keys_str_mv | AT fruythooren shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT fruythooren shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT sghijselings shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT sghijselings shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT jcools shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT jcools shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT mdepypere shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT pdemunter shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT pdemunter shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT wjmetsemakers shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT wjmetsemakers shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT gvles shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection AT gvles shouldtreatmentdecisionsinsepticarthritisofthenativehipjointbebasedontherouteofinfection |