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Sequelae and reconstruction after septic arthritis of the hip in infants
I H Choi1, P D Pizzutillo, J R Bowen
1Department of Medical Education, Alfred I. duPont Institute, Wilmington, Delaware 19899.
Insights
Septic arthritis in infants can lead to hip deformities requiring surgical intervention. Treatment outcomes vary by deformity type, with less severe cases showing better functional results.
Area of Science:
- Pediatric Orthopedics
- Pediatric Rheumatology
- Pediatric Infectious Diseases
Background:
- Septic arthritis in children under one year old can cause significant hip deformities.
- Residual deformities require late treatment and impact long-term function.
Purpose of the Study:
- To evaluate residual hip deformity and late treatment outcomes in children with a history of infantile septic arthritis.
- To classify deformities based on radiographic changes and correlate with functional results.
Main Methods:
- Retrospective evaluation of 34 hips in 31 children treated for late effects of septic arthritis.
- Classification of hips into four types based on radiographic findings: Type I (ischemia), Type II (epiphyseal/physeal/metaphyseal deformity), Type III (femoral neck malalignment), Type IV (femoral head/neck destruction).
- Analysis of surgical interventions and functional outcomes for each deformity type.
Main Results:
- Type I hips (n=5) showed satisfactory function without reconstruction.
- Type II hips (n=11) required surgery to prevent subluxation; 7/11 had satisfactory outcomes.
- Type III hips (n=5) needed osteotomy or bone grafting; 3/4 had satisfactory outcomes.
- Type IV hips (n=13) involved complex reconstructions with only 4/13 achieving satisfactory outcomes.
Conclusions:
- Late treatment of infantile septic arthritis sequelae is complex and depends on the type of residual deformity.
- Surgical interventions can improve function, but outcomes are poorer in severe Type IV deformities involving femoral head and neck destruction.
Abstract:
We evaluated the residual deformity and late treatment of thirty-four hips of thirty-one children who had had septic arthritis when they were less than one year old. The hips were classified into four groups on the basis of radiographic changes. Type-I deformity (five hips) involved transient ischemia of the epiphysis, with or without mild coxa magna, and these hips did not need reconstruction. Type-II deformity (eleven hips) included deformity of the epiphysis, physis, and metaphysis, and these hips needed an operation to prevent subluxation; the goals of the operation included improvement in acetabular coverage, improvement in abductor efficiency by epiphyseodesis or transfer of the greater trochanter, and equalization of limb-length discrepancy by epiphyseodesis of the contralateral limb. Type-III deformity (five hips) involved malalignment of the femoral neck, with extreme anteversion or retroversion or with a pseudarthrosis of the femoral neck that necessitated a realignment osteotomy of the proximal part of the femur or bone-grafting of the pseudarthrosis. Type-IV deformity (thirteen hips) included destruction of the femoral head and neck, with persistence of only a remnant of the medial base of the femoral neck. In the hips that had a Type-IV deformity, the complex clinical problems, which included severe limb-length discrepancy and incompetent articulation of the hip, necessitated operations such as Pemberton osteotomy, trochanteric arthroplasty, arthrodesis, epiphyseodesis of the contralateral limb, and lengthening of the ipsilateral tibia. The functional result was satisfactory in all five hips that had a Type-I deformity, in seven of eleven that had a Type-II deformity, in three of four that had a Type-III deformity, and in only four of thirteen that had a Type-IV deformity.