Aim: To study the epidemiology, diagnostic criteria and outcome of Septic Arthritis (SA) of hip in infancy and childhood

Method: Retrospective case notes review of 43 cases of Primary SA of hip. Diagnostic criteria used: 1. Confirmed SA: positive joint fluid culture/positive blood culture and elevated WCC in joint fluid / radiological changes. 2. Presumed SA: Negative cultures but elevated WCC in joint fluid. The outcome was rated as A. Satisfactory: clinically and radiology normal hip. B. Unpredictable: clinically normal hip with radiological changes. C. Unsatisfactory: clinically abnormal hip.

Results: We had 37 cases of confirmed SA and 6 cases of presumed SA. Mean age of presentation was 4 years with male to female ratio of 3:2. All cases had either joint aspiration or arthrotomy. The 25% of cases with negative joint fluid cultures had a history of recent antibiotic use. Radiological changes were found in 40% cases. Mean duration of follow up was 33 months. Outcome was rated as satisfactory in 61%, unsatisfactory in 7% and unpredictable in 31%. Of confirmed SA cases 57% had a satisfactory outcome. The delay in the initial presentation was more than a week in all cases with unsatisfactory results.

Conclusions: Our study outlines the demographic and microbiological profile of SA of the hip in children. Diagnosis in culture negative cases can be challenging, especially with a history of recent antibiotic use. Prolonged initial delay in presentation was associated with unsatisfactory outcomes.

Purpose of study: Osteonecrosis is a potentially devastating condition which requires early diagnosis before articular collapse occurs. We have become aware of an increase in the number of childhood cancer survivors presenting to us with osteonecrosis. This is recognised in the literature among leukaemia survivors, particularly those treated in adolescence. In the majority of cases the hips have been affected, but shoulders, knees and ankles also appear susceptible. The presentation to orthopaedics is often late with subchondral fracture or collapse of the articular surface, which precludes any salvage of the joint. We wished to assess the extent of the problem throughout Britain.

Method: A postal questionnaire was sent to all BSCOS members. Members were asked to note their unit’s experience of childhood cancer survivors with osteonecrosis, current management strategies and if they were willing to participate in a detailed national survey of cases.

Results: 58% of respondents work in units where children with childhood cancer are treated. 37% of respondents, or their colleagues, had seen survivors of childhood cancer with osteonecrosis in the last twelve months. Most units had seen less than 5 cases per year. Of the respondents who had treated cases of osteonecrosis (n =30), management included restricted weight-bearing (29), core decompression (9) and bisphosphonates (6). Other treatment modalities used were joint distraction (2), fibular grafting (2), bone marrow injection (1), fusion (1) and arthroplasty (4).

Conclusions: We have shown that a large number of units are each seeing small numbers of cases of osteonecrosis in childhood cancer survivors. The study establishes an estimate of the problem nationally and a network of centres to continue a more detailed analysis of cases.