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Avascular necrosis as a complication of septic arthritis of the hip in children
E C Vidigal Júnior1, E C Vidigal, J L Fernandes
1Unit of Orthopaedic Surgery, Hospital Regional do Gama, Brazil.
Insights
Pyogenic arthritis can lead to avascular necrosis (AVN) in children, affecting hip joint development. Early infection diagnosis and treatment are crucial to prevent severe hip deformities and avascular necrosis.
Area of Science:
- Orthopedics
- Pediatric Rheumatology
- Infectious Diseases
Background:
- Pyogenic arthritis is a serious infection affecting children's joints.
- Avascular necrosis (AVN) is a potential complication of septic arthritis, leading to bone death.
- Understanding the radiographic and clinical progression of AVN in pediatric hip joints is essential.
Purpose of the Study:
- To classify and describe radiographic changes of avascular necrosis (AVN) in pediatric hip joints secondary to pyogenic arthritis.
- To correlate radiographic findings with age groups and long-term outcomes.
- To emphasize the importance of early diagnosis and treatment.
Main Methods:
- Retrospective study of 71 hip joints in 69 infants and children with pyogenic arthritis.
- Radiographic assessment and classification of avascular necrosis (AVN) into three age-based groups.
- Clinical follow-up for 2 to 15 years to evaluate hip joint deformities.
Main Results:
- Twenty joints (28%) exhibited radiographic signs of avascular necrosis (AVN).
- Three distinct radiographic patterns of AVN were identified based on age: epiphyseal ossification changes (Group 1), disappearance of the center with preserved head shape (Group 2), and epiphyseal involvement with density changes and potential collapse (Group 3).
- A trend towards more severe deformities was observed in older children (Group 3) compared to younger children (Groups 1 and 2) at long-term follow-up.
Conclusions:
- Pyogenic arthritis can cause avascular necrosis (AVN) in pediatric hip joints, with distinct radiographic presentations across different age groups.
- Early diagnosis and management of hip joint infections are critical to mitigate the risk of avascular necrosis (AVN) and subsequent deformities.
- Prompt treatment can potentially prevent or reduce the severity of long-term hip joint complications.
Abstract:
Seventy-one hip joints in 69 infants and children with pyogenic arthritis were studied. Twenty joints (28%) with the radiographic characteristics of avascular necrosis were identified and the changes classified into 3 groups: Group 1 (infants up to the age of 6 months) had ischaemic changes characterized by the absence or delayed appearance of the epiphyseal ossification centre; Group 2 (children aged between 7 months and 5 years) showed disappearance of this centre whether followed by revascularization or not, with the shape of the cartilaginous femoral head preserved in either case; and in Group 3 (children 6-16 years of age) the femoral epiphysis was either totally or partially involved with increased bone density; collapse of the head may or may not have occurred. At follow-up for between 2 and 15 years, a trend towards more severe deformities was seen in the 11 hip joints of Group 3 when compared to the 9 hip joints in Groups 1 and 2. The opposite was observed in relation to less severe deformities. Early diagnosis and treatment of infection is mandatory in patients with pyogenic arthritis and increased intra-articular hydrostatic pressure, or those with septic thrombosis of the epiphyseal vessels, which could cause avascular necrosis (AVN).