Septic Hip In Infancy Early Diagnosis And Management:

Samir Mohamed Zahed

Septic arthritis of the hip joint, in general, is a raredisease. It affects neonates and infants more than olderchildren or adults. After infection, the consequences on thehip joint function is widly varied but mostly unfavourableOur review of literature demonstrated the basicknowldge of the related hip joint anatomy and thepathogenesis of hip joint sepsis. We explained thepredisposing factors for hip joint infection and howneonates in the incubators are more vulnerable to suchaffection. Also, we reviewed the most common organismsproducing this lesion and the way of localization in the hipjoint. We had also, explained the clinical manifestations ofhip joint sepsis and the necessary investigations. Wediscussed the different planes of managment and lastly theprognosis and the complications encountered in thisdisease.We studied 30 cases with early hip joint sepsis toevaluate the effect of early diagnosis and managment onthe outcome of the hip joint function. AU the cases wereeither neonates (within one month of delivery) or infants(under 2 years of age). The cardinal clinial manifestationsare immobile limb (pseudoparalysis) with flexion attitudeand painful passive movement, The clinical manifestationsof hip joint sepsis were confirmed by X-ray andultrasonsography of the hip joint. The most constantradiologic findings were lateral subluxation with increasein the joint space, and rarefaction. The hip ultasonographyshowed joint effusion in most of cases, and in rareoccasions, partial head destruction. The laboratoryinvestigations (E.S.R, leukocytic count, blood culture)were quite unhelpful. Joint aspiration was very importantas a diagnostic procedure and should be practiced widely.It helps confirming the diagnosis and yielding material forbacterial idintification and antibiotic sensitivity testing.Aspiration. of 30 hip joints yeildcd pus in 23 cases whichhad been drained. Early splintage in abduction usingbilateral hip spica, Pavlik Harness or Von Rosen splint isvery vital to overcome hip joint dislocation. The antibioticchosen from the culture sensitivity report should be givenin adequate dose parenterally for one week then orally foradditional three weeks. The reduction of the head in theacetabulum is monitored by X-ray. The splintage isremoved when the hip joint seems stable outside theharness, This usually takes 2-4 months.Assesment of the results was done both clinically andradiologically. The parameters for satisfactory clinicalfunction were: normal or good range of movement, no orinsignificant shortening and absence of complicationsrequiring subsequent surgical interference. At the end offollow up 17 cases (56.7%) were considered clinicalysatisfactory and, 13 cases were considered unsatisfactorydue to the associated. complications (dislocation,epiphyseal destruction, coxa vara, shortening orsignificant limitation of movement). The radiologicasscsmcnt showed satisfactory results in 18 cases (60.0%)with unsatisfactorv results due to femoral head destructionor dislocation in 12 cases (40.0%). The mostunsatisfactory outcome was encountered in cases withdelay of managmcnt more than seven days and the bestresults were acheived if diagnosis and treatment startedwithin fourdays of affection. Also, septic arthritis caused bystaphylococcal organisms and arthritis associated withadjacent metaphyseal osteomylitis were proved to be ofpoor outcome. The use of early arthrotomy, adequatesplintage in abduction for a sufficient length of time andproper parentral antibiotic are mandatory if satisfactoryresults to be acheived.