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Kang SN, Sanghera T, Mangwani J, et al. The management of septic arthritis in children: systematic review of the English language literature. J Bone Joint Surg Br. 2009 Sep;91(9):1127-33. (Review) PMID: 19721035
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DISCIPLINE	RELEVANCE TO PRACTICE	IS THIS NEWS?
General Practice(GP)/Family Practice(FP)
Infectious Disease
Pediatric Hospital Medicine
Pediatrics (General)
Rheumatology
Surgery - Orthopaedics

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Abstract
We performed a systematic review of the optimal management of septic arthritis in children as recommended in the current English literature using MEDLINE, EMBASE, CINAHL, the Cochrane Library and reference lists of retrieved articles without date restrictions up to 31 January 2009. From 2236 citations, 227 relevant full-text articles were screened in detail; 154 papers fulfilled the inclusion criteria, from which conclusions were drawn on the management of infected joints in children. Our review showed that no single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively joint infection. The roles of aspiration, arthrotomy and arthroscopy in treatment are not clear cut, and the ideal duration of antibiotic therapy is not yet fully defined. These issues are discussed. Further large-scale, multi-centre studies are needed to delineate the optimal management of paediatric septic arthritis.

Abstract

We performed a systematic review of the optimal management of septic arthritis in children as recommended in the current English literature using MEDLINE, EMBASE, CINAHL, the Cochrane Library and reference lists of retrieved articles without date restrictions up to 31 January 2009. From 2236 citations, 227 relevant full-text articles were screened in detail; 154 papers fulfilled the inclusion criteria, from which conclusions were drawn on the management of infected joints in children. Our review showed that no single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively joint infection. The roles of aspiration, arthrotomy and arthroscopy in treatment are not clear cut, and the ideal duration of antibiotic therapy is not yet fully defined. These issues are discussed. Further large-scale, multi-centre studies are needed to delineate the optimal management of paediatric septic arthritis.

Comments from Clinical Raters
General Practice(GP)/Family Practice(FP) Probably more use to acute paediatricians than to GPs, but interesting and gives a reminder to consider this rare but significant condition in children with the relevant symptoms/signs.
Pediatric Hospital Medicine A useful systematic review but without a meta-analysis. Nevertheless, this will serve as useful information for general paediatricians and specialists alike as a summary of clinical and therapeutic aspects of septic arthritis.
Rheumatology Definitive review of current knowledge. Would consider this a must-read for rheumatologists and orthopedic surgeons who see children.

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