LAUSR

scopic appearance is an important parameter and may be used as an adjunct to other more definitive tests such as culture and sensitivity studies, it has been shown many times that a turbid appearing fluid may not be contaminated and a clear looking fluid may, instead, contain several microorganisms.2 Even in our clinical practice at our institution, we have had cases where clear SF on arthrocentesis subsequently revealed positive bacterial growth on culture media. Second, in the case where clear fluid was present, surgery was performed only after a positive laboratory test result. Many such tests, for example, serum erythrocyte sedimentation rate, Creactive protein levels, and so on, may be normal even in confirmed cases of septic arthritis and hence, have a limited utility.3 Even SF culture will demonstrate positive growth in only 80% cases of nongonococcal arthritis as many times the SF sample collection technique is poor or the sample has been collected after initiating antibiotic treatment.3 Moreover, the time taken to obtain this report has not been mentioned. Most standard aerobic culture and sensitivity studies take ~48 hours. We believe it is not prudent to delay treatment with debridement, arthrotomy, and lavage as the risks of not evacuating a septic joint, especially hip, far outweigh any potential advantage gained by waiting for the confirmatory culture report.2 In fact, on the basis of a systematic review of literature, Mathews and Coakley4 showed that no single laboratory test had the sufficient specificity required to make a diagnosis of septic arthritis beyond a reasonable doubt. Clinical suspicion of the treating physician, instead, was generally preferred to make the diagnosis. This way treatment could also be commenced immediately. Third, we agree with the authors that obtaining an ideal control group of sufficient size in pediatric septic arthritis can indeed be challenging. However, in that case, the sample size should have been bigger as it is difficult to generalize the findings of the study to the broad spectrum of the pediatric population afflicted with septic arthritis. Based on the fact that septic arthritis is an orthopaedic emergency and that the hip (which is also the most commonly affected joint in infants) is at a higher risk for chondrolysis and destruction if arthrotomy and drainage are not initiated within 48 to 72 hours of onset,2 we do not feel that the addition of a new diagnostic test is going to significantly alter the treatment protocol for this pathology. Well-designed randomized controlled trials are the need of the hour before any definitive conclusion can be drawn.