Outcomes of paediatric septic arthritis of the hip and knee at 1–20 years in an Australian urban centre

Abstract

Background: Septic arthritis in children is a joint threatening condition with potentially severe consequences; however, long-term outcome data is lacking. This study aims to determine 1-20-year outcomes following septic arthritis of hip and knee joints in children in an Australian population. Methods: All paediatric patients with septic arthritis of the hip or knee from 1995 to 2015 treated at our Australian institution were retrospectively assessed. Clinical features, treatment and investigation results were recorded. Long-term functional and radiological outcomes, infection recurrence and reoperation rate at final follow-up (mean 8.5 years, range 1.0-20.3; hip versus mean 7.7 years, range 1.1-20.3; knee) were recorded. Results: Sixty-four patients (37 hip, 27 knee) met inclusion criteria. Fifty-two patients (81.3%) attended follow-up. No mortalities or late infection recurrence occurred. Three patients (1; hip versus 2; knee) had a later operation. Median Oxford scores were excellent (48; hip versus 48; knee); however, a significant proportion had a degree of impaired function (31.3%; hip versus 42.1%; knee). Radiological outcomes were excellent in knees more commonly than hips (81.3%; hip versus 100%; knee). Conclusions: Outcomes at 1-20 years for the majority of patients following septic arthritis of the hip and knee are excellent with early joint irrigation and intravenous antibiotics. Our results demonstrate a significant proportion of patients following septic hip arthritis have mild to moderately poor functional and radiological outcomes. Those with septic knee arthritis demonstrated universally excellent radiological outcomes and mild functional impairment in approximately one-third of cases.

Long-Term Outcomes of Acute Osteoarticular Infections in Children

“…First, we assessed objective outcomes by physical examination only. This is in contrast with other studies in which diagnostic imaging was performed (6,7,11,26). We were concerned that performing diagnostic imaging routinely as part of the followup study procedures would not be acceptable for many participants and lead to a selection bias in favor of those with ongoing complaints.…”

“…A Korean study including children with hip arthritis <18 months of age observed excellent or good clinical outcomes in 84% after a mean follow-up of 6 years (26). Another study in 52 Australian children with septic arthritis reported normal function with excellent outcomes assessed by radiographic imaging in 81% of those with hip and 100% of those with knee arthritis after a mean follow-up of 8.5 years (11). A further study from the United States of America, including 134 children with acute or subacute osteomyelitis, reported excellent or good outcomes with complete clinical resolution and minor radiological changes assessed in 92% after a follow-up of 2.5 years (6).…”

“…In other follow-up studies, which also included children with OM and/or SA, joint involvement as a risk factor was not assessed (7,10). Other outcomes studies included children with either OM or SA and therefore could not assess joint involvement as a risk factor for adverse long-term outcomes (6,9,11,26). The impact of age at onset of illness and the associated skeletal maturity as well as joint involvement as risk factors for adverse outcome of osteoarticular infections should be assessed in a future, prospective study.…”

“…Antibiotics had been administered intravenously for a median (IQR) of 13 (11)(12)(13)(14)(15) days. Data on overall treatment duration was available in 76 participants and showed a median (IQR) treatment duration of 42 (37-46) days.…”

“…Long-term sequelae such as growth disturbance, bone deformity, and chronic infection have been described in 2-40% of patients (6)(7)(8)(9)(10)(11). Septic arthritis of the hip seems to be especially prone for long-term sequelae, which were reported in 47% of affected newborns and in 66% of affected children in a South African study (12,13).…”