Ilizarov hip reconstruction for late sequelae of childhood septic arthritis

Abstract

Background The management of hip instability because of septic arthritis in childhood is difficult. Ilizarov hip reconstruction (IHR) is a double-level femoral osteotomy with the objective of eliminating hip instability, through a proximal valgus extension–derotation osteotomy, and a distal varization-lengthening osteotomy for mechanical axis correction and equalization limb length.Patients and methods IHR was performed for 16 adult patients with complaints of hip pain, leg-length discrepancy, limping, reduced activity, and limited abduction of the hip as a result of childhood septic arthritis. Their ages ranged from 19 to 32 years (mean 23.2±4.2 years).Results Ilizarov external fixator was used in all cases. At the time of last follow-up, which ranged from 60 to 132 months (mean 85.6±23.5 months), the Harris hip score showed excellent functional outcome in two (12.50%) cases, good in 13 (81.25%) cases, and fair in one (6.25%) case. There was no poor functional outcome in any case. Preoperatively, the mean Harris hip score was 56.18 points, and at the time of last follow-up, it improved to a mean of 84.62 points. Pain subsided in all patients, the Trendelenburg sign became negative in all but three (19%) patients, no patient had limb-length discrepancy, and the alignment of the extremity was reestablished in all cases. No additional operations were required.Conclusion IHR is a valuable and durable solution for the late sequelae of childhood septic arthritis of the hip presenting in adult patients.