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Management of post septic hip dislocations when the capital femoral epiphysis is present
Ashok N Johari1, Arjun A Dhawale, Ratna A Johari
1Children's Orthopaedic Centre, Mumbai, India. drashokjohari@hotmail.com
Insights
Septic hip dislocation with capital femoral epiphysis (CFE) in children is a distinct condition. Open reduction often yields better outcomes than closed reduction for these challenging cases.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Pediatric Rheumatology
Background:
- Delayed diagnosis of septic arthritis in children can lead to severe hip complications.
- Existing classifications do not adequately describe post-septic hip dislocations with capital femoral epiphysis (CFE).
Purpose of the Study:
- To describe the distinct entity of septic hip dislocation with CFE in children.
- To evaluate the outcomes of various surgical interventions for this condition.
Main Methods:
- Retrospective review of 21 hips in 18 children with septic hip dislocation and CFE.
- Interventions included closed reduction, open reduction, and supplementary procedures.
- Clinical (Ponseti score) and radiological (modified Severin grading) assessments were performed.
Main Results:
- Open reduction was successful in 13 of 14 hips, compared to 7 of 20 hips with closed reduction.
- Good clinical results were achieved in 50% of cases at a mean 6.3-year follow-up.
- Femoral varus osteotomy may lead to coxa vara, but interventions resulted in stable, functional hips short-term.
Conclusions:
- Septic hip dislocation with CFE is a unique clinical entity requiring specific management.
- Magnetic resonance imaging (MRI) aids in treatment planning.
- Many patients require open reduction and additional procedures for optimal outcomes.
Abstract:
Delayed or missed diagnosis of septic arthritis of hip in children results in various sequelae. The group of post septic hip dislocations when the capital femoral epiphysis (CFE) is present has not been described in the commonly used classifications. This is a retrospective series of 21 hips in 18 children. The presence of the CFE was confirmed radiologically or at the time of intervention. The mean follow-up after intervention was 6.3 years. Interventions for dislocations included closed reduction ± adductor tenotomy, open reduction ± supplementary femoral procedures, and acetabular procedures. Results were evaluated clinically with Ponseti hip scoring and radiologically with the modified Severin grading. Closed reduction was successful in seven of 20 hips (35%) and open reduction in 13 of 14 hips. At follow-up, good clinical result was seen in nine of 18 cases (50%). The mean neck shaft angle was 129° in all hips and 124° after femoral varus osteotomy. There was one redislocation and three subluxations. The modified Severin classification was class 2 in five hips (good), class 3 in 12 hips (fair), class 4 in three hips (poor), and class 6 in one hip (failure). Septic hip dislocation with CFE present is a distinct entity. MRI is helpful for planning treatment. A significant number of patients need open reduction with other procedures. Femoral varus osteotomy may contribute to coxa vara. In the short term, intervention results in a stable, functional, and mobile hip.
