THE MANAGEMENT AND OUTCOME OF PAEDIATRIC SEPTIC ARTHRITIS OF THE HIP

Abstract

Introduction: There is a paucity in the literature regarding the long term outcome of children with septic hips. Often, there is a delay in diagnosis which may lead to complications such as growth arrest, deformity and leg length discrepancy. We investigated the outcome of these patients and report the observed complications.

Methods: We performed a retrospective review of all children who underwent arthrotomy and washout for septic arthritis of the hip over a ten year period. Patients were identified from hospital databases and the coding department. Medical records were reviewed and data including demographics, method of presentation, laboratory investigations and outcome were recorded.

Results: We analysed the records of 70 patients who underwent formal arthrotomy and washout of their septic hip. Two patients had bilateral washouts (n = 72 hips). There were 36 (51%) female patients. 24 patients were under 1 year of age at presentation, with 11 of these in the neonatal period.

Temperature data was available for 48 patients, with a mean of 38.2 degrees Celsius at presentation. The mean ESR was 55.8. 28 patients (40%) grew an organism on culture of the hip fluid. The most common organism was Staphylococcus Aureus (64% of positive cultures).

66% (n=16) of patients in the < 1 year old group developed complications relating to growth arrest and leg length discrepancy. Seven of these patients (43%) underwent further surgery to correct deformity at a later date. In contrast, only 4.3% of patients in the > 1 year old group developed complications. The mean delay to surgery in patients who developed complications was 6.3 days with a mean delay to surgery of 3.1 days in patients who did not develop complications (p = 0.03, student’s T-Test).

Discussion: Paediatric Septic Arthritis remains a complex issue for both the patient and the surgeon. We have demonstrated that an increased delay in patients undergoing washout can lead to increased complications although this predominantly affects patients under 1 year of age. This can be explained by the lack of clinical signs in a < 1 year old child. Clinicians should have a high index of suspicion of septic arthritis in patients with features of sepsis with an unknown cause.