Tractionless Hip Arthroscopy in Children With Suspected Septic Arthritis of the Hip: A Comparative Cohort Study

BACKGROUND: Tractionless hip arthroscopy has emerged as a portal-based alternative to traditional open arthrotomy for children requiring operative treatment for suspected septic arthritis of the hip. However, comparative clinical outcome data remain limited. The purpose of this study was to compare outcomes following tractionless hip arthroscopy and arthrotomy in children undergoing operative treatment for suspected septic arthritis of the hip. METHODS: We performed a retrospective cohort study of children who underwent operative irrigation and drainage for suspected septic arthritis of the hip between 2009 and 2025. The choice of operative approach reflected surgeon preference and increasing institutional experience with tractionless hip arthroscopy over the study period. Demographic characteristics, disease severity, operative variables, and postoperative outcomes were compared using unadjusted univariate analyses. RESULTS: A total of 164 children underwent operative treatment, including 34 treated with tractionless hip arthroscopy and 130 treated with arthrotomy. Children treated arthroscopically had higher initial inflammatory marker values and more frequent contiguous osteomyelitis. Operative time, hospital length of stay, repeat surgery, emergency department return, hospital readmission, and observed sequelae during available follow-up did not differ statistically between groups. The mean 48-hour C-reactive protein change was -2.7±6.7 mg/dL after arthroscopy and +0.23±6.0 mg/dL after arthrotomy (P=0.005); postoperative oral morphine equivalents were 12.9±22.1 and 28.6±55.2, respectively (P=0.020). These unadjusted secondary findings were considered exploratory. CONCLUSIONS: Tractionless hip arthroscopy was feasible and was not associated with an obvious increase in short-term treatment failure in this exploratory cohort. The findings do not establish equivalence, superiority, or long-term comparative safety. Prospective multicenter investigation with longer follow-up is warranted. LEVEL OF EVIDENCE: Level III-retrospective cohort study.