Related Experiment Videos
Radiodense lines and subclinical infection in pediatric hip surgery
1Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque.
Abstract:
A subtle radiolucency with surrounding sclerosis was seen in 14 of 129 hip implant removals in 90 children. Five of these implants were cultured, and all five grew Staphylococcus epidermidis. The other nine were not cultured. None of the 14 had sequela. These radiographic findings should prompt suspicion of infection even in the absence of clinical or laboratory findings; they should also prompt hardware removal.
Insights
Subtle hip implant changes in children may indicate infection, even without symptoms. Radiographic findings of radiolucency and sclerosis suggest infection and warrant hardware removal.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Infectious Disease
Background:
- Hip implants are common in pediatric orthopedic surgery.
- Periprosthetic joint infection (PJI) is a serious complication following implant surgery.
- Early detection of PJI is crucial for successful treatment and preventing long-term sequelae.
Purpose of the Study:
- To investigate subtle radiographic findings associated with hip implant infections in children.
- To determine the correlation between specific radiographic signs and bacterial cultures.
- To assess the clinical significance of these findings in pediatric hip implant cases.
Main Methods:
- Retrospective review of 129 pediatric hip implant removals.
- Analysis of radiographic findings, specifically radiolucency and sclerosis around the implant.
- Bacterial culturing of explanted hardware in a subset of cases.
- Correlation of radiographic findings with clinical and laboratory data.
Main Results:
- Subtle radiolucency with surrounding sclerosis was observed in 14 of 129 (10.9%) hip implant removals.
- Staphylococcus epidermidis was identified in all five cultured implants from this subgroup.
- None of the 14 children with these radiographic findings experienced sequelae.
- No clinical or laboratory evidence of infection was reported in these cases.
Conclusions:
- Subtle radiographic changes (radiolucency and sclerosis) around hip implants in children can be indicative of subclinical infection.
- These findings warrant suspicion for infection, even in the absence of overt clinical or laboratory signs.
- Prompt hardware removal should be considered when these radiographic signs are present in pediatric hip implants.