SEQUELAE AFTER SEPTIC ARTHRITIS OF THE HIP IN CHILDREN

Abstract

Septic arthritis of the hip is the commonest joint infection and unfortunately the most devasting location. The most serious complication of the pyogenic arthritis of the hip in children and especially in newborns and infants is avascular necrosis of the femoral head which can lead to partial or complete destruction of the capital femoral epiphysis, the growth plate or both.

The aim of the study was to evaluate the residual deformity after late treatment of septic arthritis of the hip in infancy.

The present study included the review of 112 children under the age of 15 with bacteriologically proven septic arthritis of the hip in Prishtina University Hospital-Paediatric Orthopaedic Unit between September 1985 and January 2002. Their ages ranged from 7 days to 14 years, 72 boys and 40 girls with 112 involved hips. All underwent joint aspiration monitoring by real-time ultrasonography and fluid analysis including culture. On the anterior image the distance between the anterior outline of the femoral neck and the anterior joint capsule was measured in millimeters. The length of the follow-up was 3–20 years.

Delay in Hospital admission was observed in 30 (27%) of patients. Eighty-two (73%) were admitted during the first week after onset of complaints. ESR was elevated initially in 87.5% of the cases. The mean ACD in hips with septic arthritis was 13.5mm (ST=0.75mm) and 3.9mm (ST=0.45 mm) in the asymptomatic hips. There was a significant difference in mean ACD for affected and unaffected sides. Complications were: one patient died from sepsis complications. In 14 patients (12.5%) there was destruction of the joint cartilage; pathological dislocation of the hip in 12 cases, 10 of whom were under the age of 6 years; also there were growth changes because of physeal arrest in 6 cases.

Delay in diagnosis and failure to begin treatment promptly are the most common reason for late complication of infection. Poor prognostic factor was also the patient age if it was less than 1 year.