Active septic arthritis of the hip in adults: what's new in the treatment? A narrative review

Septic arthritis of the hip in adults is a rare disease with important and serious sequalae if not immediately and correctly treated. An early diagnosis is essential in order to avoid complications that could invalidate patients quality of life: a multidisciplinary approach is usually requested and recommended. Staphylococcus aureus is the most common finding among the different bacteria identified, and the clinical presentation is extremely aspecific. Based on symptoms, radiological signs, serum tests, synovial aspirates and bacterial cultures, different treatment could be performed. The surgical treatment goal should be to wash the hip joint with high volume of saline solution in addition to a specific antibiotic therapy. Different techniques and strategies are described in literature: arthroscopic surgery allows a direct visualization of the joint and a synovial debridement, as well as washing the joint with very high volume of fluid. Other open techniques with more extensive debridement are described, but in case of bone destruction an open two-stage technique is indicated with the cement spacer implant. No statistically significant differences have been demonstrated in the scientific literature between open or arthroscopic techniques in terms of infection recurrence. Each technique has advantages and disadvantages that the surgeon should take into account in order to offer the best treatment to the patient. The antibiotic-loaded cement spacer is strongly recommended during the two-stage open arthroplasty and Girdlestone technique remains a valid option in selected patient, both as primary or salvage treatment.