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Septic arthritis of the hip in infancy: end result study
Insights
Septic arthritis in infants can lead to hip joint issues. Early surgical intervention, like open reduction or trochanteric arthroplasty, offers better outcomes for hip stability and function.
Area of Science:
- Pediatric Orthopedics
- Rheumatology
- Surgical Innovation
Background:
- Infantile septic arthritis can cause significant hip joint destruction.
- Long-term sequelae include femoral head deformity and dislocation.
- Accurate assessment of hip damage in early childhood is challenging.
Purpose of the Study:
- To evaluate the long-term outcomes of hip joint management following infantile septic arthritis.
- To determine the efficacy of different surgical interventions based on hip joint status.
- To identify optimal timing and methods for surgical correction.
Main Methods:
- Longitudinal follow-up of 21 patients (24 hips) treated for infantile septic arthritis over 11-30 years.
- Analysis of treatment outcomes based on initial femoral head destruction and dislocation.
- Comparison of closed treatment, open reduction, and trochanteric arthroplasty.
Main Results:
- Closed treatment was successful for hips with minimal to moderate femoral head destruction.
- Open reduction yielded good results when a stable reduction was achievable.
- Trochanteric arthroplasty was performed in 6 hips with absent femoral head-neck and iliac dislocation, with varied outcomes.
- Push-pull X-rays were found more reliable than arthrography for assessing joint location in early years.
Conclusions:
- Early surgical intervention is crucial for managing hip instability post-septic arthritis.
- The choice of surgery (open reduction vs. trochanteric arthroplasty) depends on the extent of femoral head-neck preservation.
- Trochanteric arthroplasty can provide a stable, though mobile, joint, improving anatomical conditions for future joint replacement.
Abstract:
Twenty-four hips in 21 patients suffering septic arthritis at infancy were followed 11-30 years (mean 17 years). Fourteen hips with none to moderate femoral head destruction proved to have a fairly good chance of becoming located following closed treatment. If it failed, open reduction was successful, provided the femoral head-neck was big enough to achieve a stable reduction. Out of the 10 hips with absent femoral head-neck and an iliac dislocation, 6 underwent trochanteric arthroplasty: 3 hips remained located though with limited motion, and one of the 3 became painful requiring arthrodesis. Two redislocated and one subluxated. Following infantile septic arthritis, the proximal femur may remain cartilaginous during the first years of life. Arthrography did not prove helpful in evaluating the hip damage, nor the remnant bone stock. During this stage, push-pull X-rays seemed the most reliable method to assess joint location. Only surgical exploration gave a definite evidence of the amount of hip destruction. If the hip persists unstable after the septic process is well under control, surgical exploration is indicated, at about one to 2 years of age. Open reduction should be performed if there is sufficient head-neck to achieve a stable reduction. Otherwise, a trochanteric arthroplasty seems the procedure of choice followed by a varus osteotomy if there is progressive subluxation. If successful, it will provide a stable joint, less length discrepancy and a limited motion which seems preferable than accepting a high iliac dislocation. It will also offer a better anatomical condition for joint replacement, if indicated at a later age.