Needle arthroscopy in the surgical management of septic arthritis of the shoulder joint in neonates and infants.

Septic arthritis in neonates and infants is a life-threatening condition which should be treated promptly to reduce morbidity and mortality. The chondrolytic effect of bacteria and proteolytic enzymes is well documented. Surgical management consists of repeated needle aspirations in one sitting, arthroscopic washout or arthrotomy for open washout. In very small children, it is difficult to perform arthroscopy using conventional endoscopes. Arthrotomies carry significant risks including iatrogenic injury to the key structures given the small size of patients. It can also leave unsightly scars and the approach to the joint can be challenging. We present two cases of shoulder septic arthritis managed successfully using needle arthroscopy. This technique involves a 1.9 mm Arthrex 'NanoNeedle Scope' (Naples, Fl, USA) in a 2.3 mm cannula. A second portal can be used for joint sampling, debridement and irrigation outflow. Both children recovered with no repeated washouts necessary and excellent clinical results at an average follow-up of one year.