Outcome of acute septic dislocation of hip in children reduced at arthrotomy

Abstract

Background: Pathological dislocation of hip following episode of septic arthritis is a long recognized complication. We determined clinicoradiological outcome in 14 children presenting with acute septic dislocation of hip and reduced at the time of emergency arthrotomy and drainage. Methods: The retrospective study was conducted at a tertiary care health centre located at suburb of a low income country. The study involved a 10 years chart review of children with confirmed septic arthritis of hip presenting with complication of acute joint dislocation and treated with open reduction at the time of arthrotomy and surgical drainage. All included patients were provided postoperative abduction splintage for minimum 3 months. The clinical evaluation at final follow up was done using modified Moon's criteria for outcome assessment. The radiological outcome was analyzed in terms of containment (Severin class), sequelae (Choi radiological types) and effect on acetabular development (acetabular index, AI). The AI on normal and reduced sides was compared statistically. Results: Average patient age at the time of presentation was 7.2 months and follow up available was 32 months (range, 12e70 months). Functionally, 5 had excellent and 6 had good outcomes at the final follow up. Two patients had fair whereas 1 had poor outcome. Seven hips were Severin class II, 4 class III and 2 class IV and 1 was class VI. One patient had Choi type IA, 3 type IB, 8 type IIA, 1 type IIB and only 1 had type IVA at follow up. The mean AI of reduced hip was 23.4 and was significantly higher than that of unaffected side (mean 15.7 ). Conclusions: The complication of acute septic dislocation of hip in children may not have a sinister prognosis as commonly believed. These hips however were associated with significant acetabular dysplasia in the follow up period.

Reconstructive and restorative interventions at the proximal end of the thigh and pelvic bones in destructive pathological dislocation of the hip in children after hematogenous osteomyelitis

“…Operations of open reduction of the head and stump of the femoral neck were reduced to opening the hip joint, revision of the proximal end of the femur and the cavity, the obligatory removal of the interpolate formed from the scar tissue, and intertrochanteric shortening detorsion-varizing-"lengthening" and economical cutting of the osteotomy. With the growth of children, the lateralization of the femur gradually increased, which contributed to the restoration of the function of the gluteus medius and small muscles (Agarwal & Rastogi, 2021;Agarwal & Gupta, 2012). Achieved movement in the joint within the normal range of 800, abduction remained slightly limited, but we did not notice leading contractures in the long term.…”

Treatment of Stage I-III Hip Joint Tuberculosis With Open Surgical Debridement and Hip Spica in Children: A Retrospective Study

“…After open surgical debridement, some authors recommended a hip spica for 4 to 6 weeks or even several months, which usually was absent for the arthroscopy procedure. 24 – 26 …”

“…After open surgical debridement, some authors recommended a hip spica for 4 to 6 weeks or even several months, which usually was absent for the arthroscopy procedure. [24][25][26] Pathologic dislocation or subluxation is a less common complication of hip infective arthritis, which could lead to severe joint dysfunction and difficulty in management. 6,26 Campbell and Hoffman 27 reported an incidence of pathologic hip dislocation due to HTB as high as nearly 17%.…”

“…[24][25][26] Pathologic dislocation or subluxation is a less common complication of hip infective arthritis, which could lead to severe joint dysfunction and difficulty in management. 6,26 Campbell and Hoffman 27 reported an incidence of pathologic hip dislocation due to HTB as high as nearly 17%. Hip spica was a common procedure used in the treatment or prevention of hip dislocation in young patients, especially for these unstable hip joint after surgery.…”

“…The other difference between open surgery and arthroscopy procedure was the use of postoperative spica. After open surgical debridement, some authors recommended a hip spica for 4 to 6 weeks or even several months, which usually was absent for the arthroscopy procedure 24–26…”