Minimally Invasive Surgical Innovations: The Promise of Tractionless Arthroscopy

Tractionless arthroscopic irrigation and debridement rapidly reduced pain and inflammation in adults with suspected hip septic arthritis in a recent single-center series, offering a minimally invasive alternative to traction-based approaches.

This finding comes from a single-center retrospective series of 15 adults treated for suspected hip septic arthritis between 2014 and 2023, each with at least one year of follow-up. The report excluded prior hip surgery and overt proximal femoral osteomyelitis; procedures were standardized as tractionless arthroscopic irrigation and debridement and outcomes were abstracted from hospital records, including pain, CRP, culture yield, and complications.

Median pain fell from 7 to 1 on the visual analog scale and median CRP dropped from 115 mg/L to below the assay threshold (<5 mg/L) after the procedure, signaling marked symptomatic and inflammatory resolution with tractionless arthroscopy. Reported analyses showed large effect sizes and statistically significant reductions at discharge, consistent with a prompt biologic response to irrigation and debridement.

Synovial cultures were positive in 26.7% of cases; methicillin-sensitive Staphylococcus aureus accounted for half of positive isolates, with Brucella and Enterobacter also identified. The modest culture yield in this cohort supports empiric coverage for common Gram-positive pathogens while remaining adaptable to local microbiology and patient risk factors.

No perioperative complications or infection recurrences were reported during the minimum one-year follow-up, supporting a favorable short- and medium-term safety profile for the tractionless technique. The series also identified tenosynovial giant cell tumor on histopathology in a subset of culture-negative cases, underscoring that noninfectious mimics can present with identical clinical and laboratory features and that tissue diagnosis may alter management when cultures are negative.