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.

Acute haematogenous osteomyelitis in children occurs in metaphysis of a long bone, and the diagnosis is usually made within 48 hours of the onset of symptoms. From 1985 to 2001 we identified 682 cases with admission diagnosis of acute haematogenous osteomyelitis, which were treated in our hospital. Early diagnosis is essential to successful treatment. We excluded all patients without either radiological or bacteriological confirmation of the diagnosis those with a history of penetrating wound. Of 682 cases included in the full series, 320 or 47% fulfilled the diagnostic criteria. Of 320 cases, 173 (54%) the infection were on the right and 147 (46%) on the left. Five cases were multifocal, 47 cases were aged one year or less, in percent 14.6%. The principle of treatment were: identification of the organism, selection of the correct antibiotic, delivery of the antibiotic in sufficient concentration and for sufficient duration and arrest of destruction. In about 80% of cases Staphylococcus aureus was isolated. The reason for a fall in the incidence of Staphyloccocus aureus are not clear. Improvements in living standards, personal hygiene, and in the general health of population may well be responsible for decreased prevalence of Staphylococcus aureus. Oral administration of antibiotics is instituted after an initial good clinical response is seen during intravenous administration, and generally we use parenteral antibiotics for the first 21 days. Long-term follow-up of all patients is necessary, including the patient with an apparantly good early result.