THE LONG TERM EFFECTS OF THE SEPTIC HIP ARTHRITIS IN CHILDHOOD

Abstract

Pyogenic arthritis of the hip in childhood despite improved antibiotic therapy remains a serious disorder which demands early diagnosis and prompt treatment. The most serious complication of the pyogenic arthritis of the hip in childhood and especialy in newborns and infants is the avascular necrosis of the femoral head which can lead to partial or complete destruction of the capital femoral epiphysis, the growth plate or both. This destruction may lead to hip joint deformity, leg length discrenpancy and dysfunction.

The PURPOSE of this study was an effort to determine the factors which affect the outcome of the hip joint in pyogenic arthritis. The present study included 37 children, 24 boys and 13 girls, with 37 involved hips. Their ages ranged from 10 days to 1 year old in 17 children and from 1y-11 years old in 20 children. All patients were hospitalized and treated in our Orthopaedic Department during 1983–1995 with proven pyogenic arthritis. All children were suspected to have pyogenic arthritis of the hip from the history, clinical features, laboratory and imaging findings and were confirmed with positive aspiration in 35 patients. In two negative aspirations the pyogenic arthritis was confirmed after surgical intervention. The treatment consisted of I.V. and oral administration of appropriate antibiotics and cast immobilization for about six weeks. In only 23 patients was immediate incision and surgical drainage performed with debridement of the hip joint, and removal of the panus on the cartilage. The length of the follow up was 7–16 years. The hips were classified according to radiographic findings into 3 groups. TYPE I (31 Patients, 84%) Normal overgrown femoral head. TYPE II (3 Patients, 8%) Deformed femoral head. TYPE III (3 Patients, 8%) Partial or complete destruction of the proximal femoral epiphysis. The evaluation and analysis of the results revealed primarily that delay in diagnosis lead to delayed treatment particularly in neonates and infants. Other factors which have an unfavorable outcome in the pyogenic hip arthritis are the multiple location, osteomyelitis of the hip region and the causative organism. Rapid diagnosis followed by immediate aspiration with surgical drainage and early administration of an appropriate antibiotics lead to good or excellent results.