Re: Treatment of early septic arthritis of the hip in children: comparison of results of open arthrotomy versus arthroscopic drainage

We have read Dr. El-Sayed’s paper with interest and would like to congratulate him on his well-performed study [1]. The comparison of the two surgical techniques proves that the treatment principle is pus evacuation in any possible technique. We have previously published a paper on the use of repeated ultrasound-guided hip aspirations to treat septic arthritis of the hip [2]. The hips were aspirated and lavaged daily in the ultrasound suite without the need for surgical intervention and without complications. Our good medium-term results demonstrated that repeated aspirations can be used with very good outcomes and safety.

The author has mentioned our paper in the context of preoperative diagnostic hip aspiration, but did not quote it in his discussion as an alternative technique for the treatment of hip septic arthritis. We believe that repeated hip aspirations are the best treatment option for the child with septic arthritis of the hip, and that surgical intervention, either arthrotomy or arthroscopy, should be reserved only for the rare patient who does not respond to treatment after 2–3 aspirations. We are happy to say that we have performed only four arthrotomies in the last 12 years, and that our technique has become the usual practice in several pediatric orthopedic departments in Israel.