Abstract
In order to assess the incidence of avascular necrosis (AVN) following septic arthritis of the hip in children, we retrospectively reviewed the outcome of 227 hips with septic arthritis treated over an 18-year period. The mean age at presentation of the 221 patients, six of who had bilateral conditions, was 5.6 years (5 months to 14 years).
All patients underwent open arthrotomy and pus was found at surgery. Patients were treated with cloxacillin and patients aged six months to two years also received ampicillin. Staphylococcus areus was cultured in 51% of hips, Haemophilus influenzae in 9%, Streptococcus pneumoniae in 4% and Streptococcus pyogenes in 6%. The remaining 30% had no growth. Septicaemia was present in 20 patients at presentation.
AVN developed in 24 hips (10.5%), and chondrolysis in five (2.2%). Of the hips with AVN, seven were septicaemic. The most important factor in the development of AVN was a delay of five or more days from onset of symptoms to surgery. The risk of AVN with five days’ delay was 50% and increased exponentially with a longer delay. Septicaemia did not constitute a risk per se, but did contribute to a delay in diagnosis of hip involvement. The total head was involved in 14 of the 24 hips with AVN, while 10 had partial head involvement, with a better long-term outcome.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
