Management of Persisting Septic Arthritis of Large Joints in Infants

IntroductionInfantile joint sepsis is potentially a crippling disease. Persisting septic arthritis can result in disastrous complications. Prompt diagnosis, surgical drainage and appropriate antibiotics are crucial in its management.ObjectivesThe purpose of this study was to present our experience in management of persistent (more than 4–8 weeks) large joint septic arthritis in infants with a 2 year follow-up, and to suggest a management protocol for these cases.Materials and MethodsRetrospective analysis of 19 infants with persistent septic arthritis was done, who were initially treated elsewhere and then presented at Indraprastha Apollo Hospitals, New Delhi. Infants presenting with local symptoms and involving a single major joint were included and were investigated thoroughly. After ruling out infection elsewhere, arthrotomy, joint debridement and decompression of adjacent long bone metaphysis was done. Material from these 3 places was sent for C/s. All patients were followed up for minimum period of 2 years. We assessed the clinical, biological and radiological data at admission and analyzed the results of culture and sensitivity. Staphylococcus was the offending organism in majority. Apart from joint and limb care, appropriate I/V antibiotics were started and continued for a minimum period of 4 weeks followed by oral antibiotics for 2 weeks.ResultsThe results were analysed using a well-defined criteria adopted in past studies. There were 8 ‘excellent', 10 ‘good’ and 1 ‘fair’ result. 79% cultures were positive. One patient had osteomyelitis(OM) of whole humerus and another had pathological hip dislocation with femoral OM. The range of motion of these joints was affected initially but normalized with time. Former had ‘good’ but latter had a ‘fair’ result.ConclusionIt is imperative to follow an aggressive approach towards any bone and joint infection in infants even when they present relatively late. Arthrotomy and thorough surgical debridement are mandatory. A diligent attempt should be made to isolate the offending organism. Suitable antibiotics through appropriate route, should be given for adequate duration.