Abstract
BACKGROUND: Paediatric hip septic arthritis is a critical condition that requires prompt surgical intervention. It may occur as an isolated issue or alongside concomitant osteomyelitis, which heightens the risk of secondary surgeries and can lead to conversion to Choi IV after the initial arthrotomy. Accurately assessing the prevalence of concomitant osteomyelitis in these patients is vital. However, existing literature reveals significant variability in prevalence estimates. This review aims to clarify the occurrence of concomitant osteomyelitis in paediatric hip septic arthritis. METHODS: This study was executed in alignment with PRISMA guidelines and has been registered with PROSPERO. A meticulous search was carried out across the PubMed, Embase, and Cochrane Library databases until September 2024 to identify relevant literature. The criteria for inclusion involved studies diagnosed with paediatric hip septic arthritis, aged 18 years or younger, with at least five documented cases. To derive pooled prevalence rates from the collected data, we utilized a random-effects meta-analysis approach. The quality of the selected studies was evaluated using the Joanna Briggs Institute's assessment checklist, ensuring a comprehensive appraisal of methodological integrity. Additionally, to explore potential sources of variability among the studies, sensitivity analyses were performed via the leave-one-out method. Subgroup analyses were also conducted focusing on three significant factors: age, geographical region, and overall study quality. RESULTS: A total of 21 studies were incorporated into the final analysis, which included 684 paediatric cases of septic arthritis of the hip. The meta-analysis produced a pooled prevalence estimate of concomitant osteomyelitis in this population at 33.2% (95% CI: 27.3-39.8). Notably, significant heterogeneity was identified among the studies (I² = 59.414%; P < 0.001). Furthermore, statistically significant differences were observed based on continent (Europe, Asia, or America) (P = 0.008) and study quality (High or Fair) (P = 0.003). CONCLUSION: This systematic review and meta-analysis identifies a pooled prevalence of concomitant osteomyelitis in paediatric hip septic arthritis at 31.8-34.5%, employing rigorous methodologies such as sensitivity analyses and stratified assessments that enhance the reliability of the findings despite limitations like small sample sizes and exclusion of non-English studies. These insights are essential for guiding future research and informing treatment strategies, ultimately supporting clinicians in making informed decisions to improve patient care in paediatric orthopedics.