The diagnosis of a hip joint infection can in most cases be gleaned from the history, physical examination, laboratory tests, and plain radiographs. The suspected diagnosis is then best confirmed by aspiration and culture of the joint. In situ ations where the clinical presentation is consistent with a hip joint infection despite nondiagnostic radiographic studies and negative cultures, a synovial biopsy is indicated. This situation may arise when acute pain occurs in the face of a preexisting degenerative condition. Exacerbation of pain in hips with osteoarthritis, avascular necrosis, and inflamatory arthritides can all present with these symptoms, and it is of the utmost importance to rule out infection so that expedient treatment can be provided. Biopsy of the synovial tissue can be performed either via CT guidance or using arthroscopic techniques. In this situation, hip arthroscopy not only provides synovial tissue for culture and pathologic analysis, but also allows visualization of the intra-articular joint structure and the ability to debride and irrigate.
In situations where the diagnosis is obvious based on a positive hip joint aspiration, consideration for arthroscopic treatment requires further evaluation to determine the feasibility of this approach. When considering arthroscopic management of an infected hip, the mechanism and duration of the infectious process should be thoroughly investigated. The virulence of the organism, if identified, should also be taken into account. From a mechanistic standpoint, the only situation amenable to arthroscopic synovectomy and debridment is acute hematogenous seeding of the joint. Chronic infection, osteomyelitis, extremely virulent organisms, and local extension of a periarticular abcess are definite contraindications to arthroscopic treatment. For this reason, addition of a CT or MRI scan is absolutely necessary to evaluate the extent of the infection and to determine the appropriateness of arthroscopic versus open treatment.
Was this article helpful?