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Anne J. Spaans Department of Orthopaedic Surgery, Sint Maartenskliniek Nijmegen/Boxmeer, the Netherlands

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C.M. (Lilian) Donders Department of Orthopaedic Surgery, Meander Medical Center Amersfoort, the Netherlands

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J.H.J.M. (Gert) Bessems Department of Children’s Orthopaedics, Erasmus MC- Sophia Children’s Hospital, University Medical Center Rotterdam, the Netherlands
Department of Orthopaedic Surgery, Amphia Hospital Breda, The Netherlands

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Christiaan J.A. van Bergen Department of Orthopaedic Surgery, Amphia Hospital Breda, The Netherlands

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drainage by aspiration (arthrocentesis), arthroscopy or arthrotomy followed by intravenous antibiotics, according to the guideline of the European Society for Paediatric Infectious Diseases (ESPID). 1 However, the literature is scarce with respect to

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Enrique Gómez-Barrena Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain

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Christian Ehrnthaller Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany

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) system was designed to provide irrigation and aspiration during a single-stage reaming procedure in which the device can be used to clear the medullary canal of BM and reaming debris, specially at the femur, but has gained popularity when harvesting this

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Alexios D. Iliadis Centre for Orthopaedics, The Royal London and Barts and The London Children’s Hospitals, Barts Health NHS Trust, London, UK

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Manoj Ramachandran Centre for Orthopaedics, The Royal London and Barts and The London Children’s Hospitals, Barts Health NHS Trust, London, UK

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to antibiotics. 2 In septic arthritis, prompt clearance of the inflammatory products from the joint space is required. The exact mode (arthrotomy vs arthroscopy vs aspiration) has been the topic of controversy. Septic arthritis of the hip in

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Ismail Remzi Tözün Department of Orthopaedic Surgery and Traumatology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey

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Vahit Emre Ozden Department of Orthopaedic Surgery and Traumatology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey

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Goksel Dikmen Department of Orthopaedic Surgery and Traumatology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey

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Kayahan Karaytuğ Department of Orthopaedic Surgery and Traumatology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey

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identify the optimal time for re-implantation. 56 Synovial fluid aspiration and analyses for cell count, culture and biomarkers before re-implantation are widely used to determine the optimal time for re-implantation and to detect persistent infection

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E. Carlos Rodríguez-Merchán Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

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aggressively treated to prevent chondrocyte apoptosis and progression to synovitis, recurrent joint bleeds and ultimately end-stage osteoarthritis. These joint bleeds need the following: deficient factor intravenous replacement to 50%; joint aspiration to

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G. Ulrich Exner Orthopaedie Zentrum Zuerich (ozz), Seestrasse 259, CH 8038 Zurich, Switzerland

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Michael O. Kurrer Gemeinschaftspraxis fuer Pathologie, Caecilienstrasse 3, CH 8032 Zurich, Switzerland

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Nadja Mamisch-Saupe Klinik Hirslanden, Department of Musculoskeletal Radiology, Witellikerstrasse 40, 8032 Zurich, Switzerland

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Stephen R. Cannon BMI The Clementine Churchill Hospital, Sudbury Hill, Harrow, Middlesex HA1 3RX, Great Britain

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-operative tactical discussion in a MDT setting. Acquisition of tissue can be via open biopsy or needle biopsy. The latter includes both fine needle aspiration (FNA) and core needle biopsy. At present the most popular method is core needle biopsy. It can be assumed

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Paolo Salari Institute for Complex Arthroplasty and Revisions (ICAR), Villa Ulivella Clinic, Florence, Italy

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Andrea Baldini Institute for Complex Arthroplasty and Revisions (ICAR), Villa Ulivella Clinic, Florence, Italy

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laboratory abnormalities or in suspected cases with an unclear cause of failure, joint aspiration is highly recommended. 5 Synovial fluid analysis permits, with a single procedure, assessment of leucocyte count, polymorphonuclear cells percentage and to

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Tamer El-Sobky Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

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Shady Mahmoud Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

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antibiotic intake may alter their diagnostic utility. 5 , 18 , 28 – 36 Nonetheless, a recent study suggested that synovial fluid cell count of polymorphonuclear leukocyte is not influenced by intake of antibiotics prior to aspiration of various joints

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John Edwin Kings College Hospital, London, UK

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Shahbaz Ahmed Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK

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Shobhit Verma Kings College Hospital, London, UK

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Graham Tytherleigh-Strong Cambridge University Hospitals, UK

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Karthik Karuppaiah Kings College Hospital, London, UK

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Joydeep Sinha Kings College Hospital, London, UK

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. CT and MRI are more sensitive as well as specific in detecting certain pathologies. 69 , 70 , 71 Aspiration of the joint under ultrasonography (USG) or CT guidance can help in isolating organisms and demonstrating crystals. 72 – 74 We

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Richard Peter Almeida Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Lipalo Mokete Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Nkhodiseni Sikhauli Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Allan Roy Sekeitto Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Jurek Pietrzak Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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wound discharge or dehiscence. 71 If antibiotic therapy is chosen there should be a strong indication and prior to administration of any antibiotics, aspiration of the wound is suggested to confirm established infection and direct the therapy. 23

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