Failure of a Single Surgical Debridement in Septic Arthritis of the Native Hip
Failure of a Single Surgical Debridement in Septic Arthritis of the Native Hip
Septic arthritis of the native hip poses significant diagnostic and therapeutic challenges as
 it is considered an orthopedic emergency requiring urgent surgery. Inadequate or delayed
 treatment is disastrous, resulting in irreversible destruction of the joint. Initial
 treatment usually comprises of arthroscopic or open debridement. According to literature
 25-38% of first debridement fail, requiring a second or third intervention or even a staged
 procedure with femoral head resection and a temporary antibiotic-loaded cement spacer.

 Understanding who will succeed and who will fail after a single surgical debridement of a
 septic hip joint could improve shared decision-making and could help decide which patient
 would benefit from resection arthroplasty straight away.

 In order to gain more insight in clinical factors associated with failure of a single
 surgical debridement in septic arthritis of the native hip, a retrospective cohort study will
 be conducted. There are no detailed guidelines for the treatment of septic arthritis of the
 native hip. Therefore, treatment today is similar to treatment 10 years ago (i.e. the
 treating surgeon does what he thinks is best for the patient). This lack of a structured
 approach is the reason for this retrospective study and we aim to come up with principles to
 guide treatment of future patients.
Septic arthritis of the native hip poses significant diagnostic and therapeutic challenges as
 it is considered an orthopedic emergency requiring urgent surgery. Early diagnosis remains
 difficult as the golden standard is based on microbiological confirmation of bacteria in
 synovial fluid or solid tissue biopsies, which can take up to a minimum of 3-5 days or
 longer. Inadequate or delayed treatment is disastrous, resulting in irreversible destruction
 of the joint. Initial treatment usually comprises of arthroscopic or open debridement. In
 comparison to septic arthritis of the knee, patients are more often less fit and the joint is
 less accessible for arthroscopic intervention. Initial surgical debridement should be
 performed within 24 hours of occurrence. According to literature 25-38% of first debridement
 fail, requiring a second or third intervention or even a staged procedure with femoral head
 resection and a temporary antibiotic-loaded cement spacer.

 Understanding who will succeed and who will fail after a single surgical debridement of a
 septic hip joint could improve shared decision-making and could help decide which patient
 would benefit from resection arthroplasty straight away. Factors such as a history of
 inflammatory arthritis, diabetes, a synovial-fluid nucleated cell count of > 85.0 x 10^9
 cells/L, S. aureus, delay to surgery and positive cultures of drain fluid were associated
 with failure of initial debridement, but have not been validated. Considering the increased
 use of MRI and nuclear imaging in the work-up of these patients, there might be additional
 useful risk factors, such as extra-articular manifestation of the infection, AVN of the
 femoral head, severe degeneration of the joint, multi-joint involvement, SUV-max values on
 FDG-PET-CT and so on.

 Most literature surrounding this subject is limited to case reports and case series with
 small sample sizes. Due to the sizable amounts of tertiary references, a large population of
 transplant patients treated at the institution UZ Leuven Gasthuisberg, and the own experience
 of the investigators, the investigators are convinced that the population size at is
 substantially larger.

 In order to gain more insight in clinical factors associated with failure of a single
 surgical debridement in septic arthritis of the native hip, a retrospective cohort study will
 be conducted. There are no detailed guidelines for the treatment of septic arthritis of the
 native hip. Therefore, treatment today is similar to treatment 10 years ago (i.e. the
 treating surgeon does what he thinks is best for the patient). This lack of a structured
 approach is the reason for this retrospective study and we aim to come up with principles to
 guide treatment of future patients.
Inclusion Criteria:

 -  All microbiology reports for cases of septic arthritis of the native hip joint
 concerning synovial fluid or solid tissue cultures obtained from
 arthrocentesis/debridement of the hip, collected from January 1st 2010 to January 1st
 2020

 -  Patients are at least 18 years of age

 -  Cases with positive cultures in patients of which the initial diagnosis, treatment and
 follow-up was conducted at UZ Leuven Gasthuisberg

 Exclusion Criteria:

 - History of arthroplasty of the hip in the affected joint