Surgical Treatment of the Severe Sequelae of Infantile Septic Arthritis of the Hip

Abstract

We retrospectively reviewed 45 hips in 43 patients with severe sequelae of infantile septic arthritis of the hip to compare the efficacy of various hip reconstructive and salvage surgeries, and to propose an algorithmic treatment protocol for the different types. Ten hips were classified as Choi Type IIIA, three as Type IIIB, 14 as Type IVA, and 18 as Type IVB sequelae. A total of 78 hip surgeries and 18 limb-length equalizations (three contralateral femoral epiphysiodesis and 15 ipsilateral femoral and/or tibial lengthenings) were done. The first surgical reconstructions were done at an average age of 5.9 years (range, 1.1-14.8 years), with a 9.5-year average followup. Type IIIA hips had better functional results than the other types. In Type III hips, early realignment osteotomy of the proximal femur or bone-grafting of the pseudarthrosis was indicated. In Type IVB hips, satisfactory results were observed in only five of 10 hips treated by trochanteric arthroplasty compared with satisfactory results in all four hips treated by Ilizarov's hip reconstruction osteotomy. The latter operation seems to be better indicated in older patients with Type IVB hips, or with Type IVA hips in which previous reconstructive surgery was unsuccessful.