The Journal of Bone and Joint Surgery, Vol 72, Issue 8 1150-1165, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Sequelae and reconstruction after septic arthritis of the hip in infants
IH Choi, PD Pizzutillo, JR Bowen, R Dragann and T Malhis
Department of Medical Education, Alfred I. duPont Institute, Wilmington, Delaware 19899.
We evaluated the residual deformity and late treatment of thirty-four hips
of thirty-one children who had had septic arthritis when they were less
than one year old. The hips were classified into four groups on the basis
of radiographic changes. Type-I deformity (five hips) involved transient
ischemia of the epiphysis, with or without mild coxa magna, and these hips
did not need reconstruction. Type-II deformity (eleven hips) included
deformity of the epiphysis, physis, and metaphysis, and these hips needed
an operation to prevent subluxation; the goals of the operation included
improvement in acetabular coverage, improvement in abductor efficiency by
epiphyseodesis or transfer of the greater trochanter, and equalization of
limb-length discrepancy by epiphyseodesis of the contralateral limb.
Type-III deformity (five hips) involved malalignment of the femoral neck,
with extreme anteversion or retroversion or with a pseudarthrosis of the
femoral neck that necessitated a realignment osteotomy of the proximal part
of the femur or bone-grafting of the pseudarthrosis. Type-IV deformity
(thirteen hips) included destruction of the femoral head and neck, with
persistence of only a remnant of the medial base of the femoral neck. In
the hips that had a Type-IV deformity, the complex clinical problems, which
included severe limb-length discrepancy and incompetent articulation of the
hip, necessitated operations such as Pemberton osteotomy, trochanteric
arthroplasty, arthrodesis, epiphyseodesis of the contralateral limb, and
lengthening of the ipsilateral tibia. The functional result was
satisfactory in all five hips that had a Type-I deformity, in seven of
eleven that had a Type-II deformity, in three of four that had a Type-III
deformity, and in only four of thirteen that had a Type-IV deformity.
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