Abstract
Neonatal septic arthritis is a true orthopaedic emergency posing significant threat to life and limb.
Objective: To examine the clinical presentation, diagnosis, treatment and outcome of children presenting with septic arthritis in the neonatal period.
Design: Retrospective review of clinical notes and radiographs of children presenting over a 20 year period (1977–97).
Subjects: 34 patients with septic arthritis in a total of 36 joints.
Outcome measures: Clinical outcome was classified as satisfactory or unsatisfactory as per Morrey et al. Radiological outcome was graded I–IV as per Choi et al. Joint instability, destruction, limb length discrepancy and angular deformity were assessed.
Results: The hip joint was affected in 24 of the 34 cases. Pseudoparalysis was the most reliable clinical finding occurring in 29 out of 34 cases. Staph Aureus was isolated as the infecting pathogen in 22/34 patients. Sequelae occurred in 16 hips and 1 knee. Poor prognostic indicators were delayed diagnosis (p< 0.05) and the hip as site of infection (p< 0.01). Clinical outcome was unsatisfactory in 15 patients and satisfactory in 17 patients. Radiological outcome was Choi I or IIA (good) in 12 hips and Choi II to IV in 13 hips (poor). Multiple further reconstructive procedures were required in 15 cases.
Conclusions: Despite optimum treatment, neonatal septic arthritis results in significant long-term morbidity for a high proportion of cases.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at Irish Orthopaedic Associaton, Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11.
