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[Osteoarthritis in infants. Follow-up and treatment]
Insights
Hematogenous septic arthritis in infants often affects the hip and knee. Early intervention with aspiration and irrigation is key, while severe cases require arthrotomy, immobilization, and antibiotics to minimize long-term joint damage.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Rheumatology
Background:
- Hematogenous septic arthritis is a significant orthopedic emergency in newborns and infants.
- The hip is the most commonly affected joint, followed by the knee.
Purpose of the Study:
- To analyze the clinical features, treatment, and sequelae of hematogenous septic arthritis in 82 infants over 25 years.
- To describe surgical and non-surgical management strategies for acute septic arthritis and its long-term complications.
Main Methods:
- Retrospective review of 102 cases of hematogenous septic arthritis in infants.
- Analysis of treatment modalities including joint aspiration, irrigation, arthrotomy, immobilization, and parenteral antibiotics.
- Detailed assessment of joint sequelae and proposed treatment options for hip joint deformities and dislocations.
Main Results:
- 102 cases observed in 82 infants, with the hip (63 cases) and knee (23 cases) being most affected.
- Early diagnosis and treatment led to better outcomes, while delayed or severe cases resulted in 52 sequelae.
- Various surgical techniques, including osteotomies and joint reconstructions, were employed to manage hip joint sequelae.
Conclusions:
- Prompt diagnosis and appropriate management of hematogenous septic arthritis are crucial to prevent severe joint destruction and long-term sequelae in infants.
- Surgical interventions are often necessary to correct deformities and dislocations resulting from septic arthritis, particularly in the hip.
Abstract:
For 25 years, 102 hematogenous septic arthritis have been observed in 82 newborns and infants. The hip joint was the most commun site of involvement (63 cases), than the knee (23 cases), the shoulder (7 cases), the elbow (5 cases), the ankle (3 cases) and one wrist. 14 times, two or more joints were involved. When the diagnosis was made early, an aspiration of pus and an irrigation of the joint was done. But in severe and delayed arthritis, an arthrotomy was preferred. In all cases, joints were immobilized in a post-operative cast or with a traction management, and parenteral antibiotics were prescribed. 52 sequellae were noted, two third of these were seen in second hand. Sequellae are detailed joint by joint, and the authors describe different stages from minor dysplasia and abnormal growth of the epiphysis to severe destruction of the bones and persistent dislocation. Treatment of sequellae is proposed: 1. The hip joint. Dysplasia and deformities of the head and/or the neck were corrected with femoral osteotomy. In 2 cases, a pelvic innominate osteotomy was performed. Progressive coxa vara with short neck and greater trochanteric overgrowth were treated with femoral neck lengthening (personal technic). Dislocations needed open reduction of the hip and extensive excision of the acetabular fibro-fatty tissue. In a few cases, a Colonna's procedure was made. In total destructions of the upper femoral extremity, the treatment consisted in trochanteroplasty. In partial epiphysiodesis of a femoral condyle, disepiphysiodesis was obtained with resection of the physeal bone bridge (2 cases) or with free free physeal transplantation with microvascular anastomosis (2 cases).(ABSTRACT TRUNCATED AT 250 WORDS)