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Total arthroplasty of the hip after childhood sepsis
1Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery, Lubbock 79430.
Insights
Total hip arthroplasty effectively restored function in adults with childhood hip pyogenic arthritis. Most patients experienced significant functional improvement without infection reactivation, though some complications occurred.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
Background:
- Childhood pyogenic arthritis can lead to long-term hip joint damage.
- Delayed treatment or sequelae of childhood hip infections often necessitate reconstructive surgery in adulthood.
Purpose of the Study:
- To evaluate the long-term outcomes of total hip arthroplasty (THA) in patients with a history of childhood pyogenic arthritis.
- To assess functional recovery, complication rates, and the need for bone grafting in this patient cohort.
Main Methods:
- Retrospective analysis of 45 total hip arthroplasties in 44 patients with a history of childhood hip pyogenic arthritis.
- Assessment of functional hip ratings pre- and post-operatively, alongside monitoring for infection reactivation and surgical complications.
- Evaluation of the union and resorption of acetabular allografts used in 60% of cases.
Main Results:
- Significant improvement in mean functional hip rating from 58 points pre-operatively to 90 post-operatively.
- No cases of infection reactivation were observed; tissue cultures were negative.
- Complications occurred in 24% of cases, including component loosening (13%) and acetabular component migration requiring revision.
- Acetabular allografts were used in 27 hips (60%) and all united, though partial resorption occurred in non-weight-bearing areas.
Conclusions:
- Total hip arthroplasty is a viable and effective treatment for managing sequelae of childhood pyogenic arthritis in adults.
- While generally successful, surgeons must be aware of potential complications such as component loosening and the need for allografts.
- Acetabular allografts demonstrate good union rates, but long-term monitoring for resorption is warranted.
Abstract:
Total hip arthroplasty was performed in 45 hips of 44 patients who had pyogenic arthritis of the hip during childhood. The average age of the patients was 36.4 years (range 19 to 50). The interval between active infection and arthroplasty ranged from 11 to 40 years, and average follow-up was 65.4 months (range 58 to 80). Specimens of tissue taken before and during operation gave negative cultures in all hips, and no patient had reactivation of infection. The mean functional rating of the hips was 58 points before operation and 90 at the final review. Complications were seen in 11 cases (24%), loosening of components occurred in six (13%) and one hip had to be revised for acetabular component migration. Acetabular allografts were required in 27 hips (60%). All allografts united but there was partial resorption of the graft in the non-weight-bearing area in all.