Septic sequelae of hip in children: long-term clinicoradiological outcome study
Anil Agarwal1, Prateek Rastogi
1Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
Insights
Infantile hip sequelae following sepsis can evolve radiologically. Early types (Choi I-II) may benefit from observation, while later types (Choi IIIB-IV) may require intervention for improved outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Infantile hip sequelae following sepsis can lead to long-term functional impairment.
- Radiological classification systems are crucial for understanding disease progression and guiding treatment.
Purpose of the Study:
- To evaluate the radiological and clinical outcomes of infantile post-sepsis hip sequelae.
- To assess the effectiveness of observation versus surgical intervention based on Choi radiological types.
Main Methods:
- Retrospective study of 18 patients (23 hips) with infantile post-sepsis hip sequelae.
- Classification using Choi's radiological types and clinical evaluation with modified Moon's criteria.
- Comparison between an observation group (6 patients) and an intervention group (12 patients).
Main Results:
- Choi radiological types demonstrated a propensity to change over time and after intervention.
- At follow-up, a significant shift towards Choi type II was observed (74%).
- Clinical outcomes ranged from excellent to fair, with multiple joint involvement and late changes negatively impacting function.
Conclusions:
- Choi type I or II sequelae are generally suitable for supervised observation.
- Surgical intervention can significantly alter the natural history of specific types of septic hip sequelae.
- Understanding radiological progression is key to optimizing management strategies for pediatric hip conditions.
Abstract:
The presented retrospective study is a report of 18 patients (23 hips) with infantile post sepsis hip sequelae. There were two groups of patients. The observation group comprised of 6 patients (8 hips). The intervention group included 12 patients (15 hips) of which 12 hips had been surgically intervened for the sequelae and 3 contralateral hips which were again serially observed. The sequelae hips were classified by Choi's radiological types. The clinical evaluation was done by modified Moon's criteria. The average patient age at follow-up was 9.3 years. There were 3 type I (13%), 10 type II (43%), 2 type III (8%), and 8 Choi type IV (35%) at presentation. The Choi radiological type showed propensity to change over time/following intervention. At follow-up, there 3 type I (13%), 17 type II (74%), and 3 type IV (13%) hips. At follow-up, there were seven excellent, seven good, and four fair results. The observation group had mostly type I or II and intervention group IIIB or IV Choi types. Findings common to both groups: same Choi radiological type fared different clinically, multiple joint involvement contributed to deterioration of function and late changes in acetabulum or proximal femur lead to deterioration of clinical function. The sequelae of septic hips likely to be kept under supervised observation were Choi type I or II. In select types, intervention changed the natural history of septic sequelae significantly.
