Acute suppurative arthritis in infancy and childhood.

In 1935 loge and Lieboit pOillted out that the attitude of the medical profession towards acute suppurative arthritis in infancy had been a singularly variable one. There had always been respect for it, but the forms of treatment advocated had been many and the principles underlying them often diametrically opposed. There has long been controversy between those favouring incision and drainage of infected joints and those who favour aspiration and treatment with specific antibiotics. In general it may be said that the chief concern of seventeenthand eighteenth-century surgeons in such cases was to preserve the life of the patient, and there was a leaning towards amputation of the limb. In the nineteenth century surgeons tried, in addition, to save tile affected limb even though it became ankylosed. With the beginning of the twentieth century came the idea of preserving the function of infected joints rather than encouraging ankylosis. Treatments advocated have included incision of the joint, repeated aspiration, complete rest and immobilisation, and disinfection of the joint with chemical or biological products: the question whether or not drainage tubes should be used after incision has remained controversial. By the 1950’s most writers believed that early diagnosis should be made and early arthrotomy performed, and that destruction of cartilage was more likely thus to be obviated than it was under treatment by repeated aspiration. Early arthrotomy has not, however, been widely practised, and in consequence the late effects of acute suppurative arthritis in infants and children are still seen today despite the wide use of antibiotics for the control of local and systemic infection. Tile literature contains, in the loam, opinions based upon theory, and there is a surprising paucity of accurate clinical review. Dissatisfied with the results oftreatment by aspiration, drainage or antibiotics, orthopaedic surgeons at the Adelaide Children’s Hospital have since 1960 treated these patients according to a strict routine, none of which is new, but which is simply a combination of accepted methods. The method is based on four main principles aild it is considered that anything short of the full routine is inadequate.