Abstract
INTRODUCTION: Septic arthritis of the hip (SAH) requires emergent surgery. While open arthrotomy has been the traditional approach, arthroscopic treatment is emerging as a safe, effective alternative. Though traction-based arthroscopy is standard, tractionless techniques, documented only in pediatric cases, remain understudied in adults. METHODS: This retrospective study evaluated fifteen consecutive adult patients (15 hips) who underwent tractionless arthroscopic irrigation and debridement for suspected septic arthritis between 2014-2023. Inclusion required clinical criteria (≥2 of: hip pain, limited range of motion, inability to bear weight, fever >38°C) AND laboratory evidence (≥1 of: leukocytosis, elevated CRP, abnormal synovial fluid analysis, or positive culture). Primary outcomes included Visual Analog Scale (VAS) pain scores, inflammatory markers, and complications. Secondary outcomes included culture results and incidental findings. RESULTS: Median age was 32 years (range 20-76), with 66.7% female patients. VAS pain scores improved from 7 (range 6-10) to 1 (range 0-3) at discharge (p<0.001). CRP levels decreased from 112 mg/L (range 35-206) to 0 mg/L (range 0-9) postoperatively (p<0.001). Positive cultures were obtained in 40% of cases (6/15), with MSSA predominating. No perioperative complications occurred within 30 days. Incidental tenosynovial giant cell tumor was identified in 33.3% of cases (5/15). During minimum one-year follow-up, no infection recurrence was observed. CONCLUSION: Tractionless arthroscopic irrigation and debridement appears to be an effective treatment for suspected SAH of the adult hip, potentially reducing the risks associated with traction and central compartment access while maintaining good clinical outcomes. The technique achieved significant improvements in pain scores and inflammatory markers with no perioperative complications.