Characteristics of Septic Arthritis of the Foot and Ankle in Children-Review of a Retrospective Multicenter Database.

Abstract

There are few publications on the presentation and management of septic arthritis of the foot and/or ankle (SAFA) in children. The purpose of this study was to describe the presenting characteristics, microbiologic profile, and treatment outcomes of SAFA in a pediatric population from a multicenter database. Patients aged 18 years or younger with SAFA were identified from a multicenter retrospective musculoskeletal infection database. Demographics, laboratory tests, culture results, surgical data, and complications were collected. A total of 684 patients were identified to have SA. Patients who had SA of the ankle and/or foot with or without concomitant lower leg musculoskeletal infection were included, yielding 82 patients (12%). The median age of the cohort was 7.0 years (range, 0.5 to 15.8 years), and 56% were male (46/82). Fifty-nine percent of the cohort had ankle-only involvement (48/82), 15% had foot only (12/82), 2% had ankle and foot (2/82), and 24% had ankle and leg (20/82). Fifty-two percent of patients had an additional diagnosis to SA, the most frequent being osteomyelitis (39/82; 48%). Ninety-four percent of patients underwent surgical irrigation and debridement, with 12 patients (16%) receiving more than one surgical intervention. Positive tissue cultures were obtained in 77% (59/79), with methicillin-sensitive Staphylococcus aureus being the most commonly identified organism. Three patients (4%) had recurrence of SAFA, and two of those patients underwent additional surgery. Musculoskeletal complications were rare, with osteonecrosis and pathologic fracture being the most common (4%). In children with SA, 12% of cases occur within the foot and/or ankle, with ankle-only involvement being the most common presentation. Methicillin-sensitive Staphylococcus aureus is the most common causative organism. In patients with SAFA, multifocal infection occurs relatively frequently, but antibiotic treatment combined with irrigation and débridement results in excellent short-term outcomes with low rates of recurrence and complications. Level IV, prognostic.