Septic Arthrits &
osteomylelitis has traditionally been managed by intravenous antibiotics for 4 to 6 weeks. This requires a prolonged in patient stay, inconvenience to parents, morbidity and unnecessary cost. A number of authors have suggested that shortened course of intravenous antibiotics 7–10 days are effective. In 2001 we started to prospectively evaluate a shortened 3 day of intravenous antibiotic regime. We prospectively treated 36 cases of acute osteomyelitis and 30 cases of acute septic arthritis in children. These were confirmed by positive blood culture, positive aspirate culture, raised WCC in joint aspirate for septic arthritis or positive bone scan/culture for osteomyelitis. These patients were treated with a shortened course (3 days) of intravenous antibiotics following surgical drainage when required. Serial measurements of inflammatory markers and clinical status were recorded. On Day 4 of admission if clinical and biochemical parameters improved patients commenced high dose oral antibiotics. If no improvement they continued IV abx and consideration for repeat washout given. Patients discharged with three week course of antibiotics. Endpoint analysis of duration of IV administration, inpatient stay, readmission/ reoccurrence was undertaken.
This studies reviews the outcomes of a short course regime started in 2001.
Patients were treated with a 3 day course of intravenous antibiotics, following surgical drainage of joints when required. Providing the clinical and biochemical parameters were improving patients then received 3 weeks oral antibiotics. The duration of IV administration and of inpatient stay and any incidence of readmission/reoccurrence was noted. Serial measurements of inflammatory markers were recorded.
Weight gain is often reported by patients who succumb to impaired activity as a result of progressive osteoarthritis of the hip or knee. Optimistic views of weight loss after joint replacement are often held by patients. We studied the affect of lower limb arthroplasty on body weight. We reviewed 144 patients having undergone hip and knee arthroplasty and were functionally well. Infected cases were excluded. Average age was 65 years and average follow up was 27 months. The Body Mass Index (BMI) was prospectively measured at follow up and compared to immediate pre-operative BMI. Our findings demonstrated an average rise in BMI post-operatively which was statistically significant. A rise in post operative BMI was seen in patients who were obese to start with or those who had undergone a total hip replacement (statistically significant). Moderate rises were seen in patients who had underwent hip resurfacing procedures or those who were overweight preoperatively (p=0.06). These findings are useful in informing patients of achievable expectations following joint replacement surgery and preoperative overweightness should be treated as a separate entity unrelated to co-existing joint degeneration.
Theoretical advantages of a one stage open reduction includes shortened hospital stay, avoidance of prolonged repeated immobilization and decreased joint stiffness. This study reports the results of single stage combined procedure for late presenting congenital dislocation of the hip in children aged 4 years and above.
Difficulties posed in managing developmental dysplasia of the hip diagnosed late include a high-placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is a well-established practice. Femoral shortening prevents excessive pressure on the located femoral head which can cause avascular necrosis. Instability due to a coexisting dysplastic shallow acetabulum is common, and so a pelvic osteotomy is performed to achieve a stable and concentric hip reduction. We retrospectively reviewed 15 patients (18 hips) presenting with developmental dysplasia of the hip aged four years and above who were treated by a one-stage combined procedure performed by the senior author. The mean age at operation was five years and nine months (4 years to 11 years). The mean follow-up was six years ten months (2 years and 8 months to 8 years and 8 months). All patients were followed up clinically and radiologically in accordance with McKay’s criteria and the modified Severin classification. According to the McKay criteria, 12 hips were rated excellent and six were good. All but one had a full range of movement. Eight had a limb-length discrepancy of about 1 cm. All were Trendelenburg negative. The modified Severin classification demonstrated four hips of grade IA, six of grade IB, and eight of grade II. One patient had avascular necrosis and one an early subluxation requiring revision. One-stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in the short to medium term.
