Sequelae Of Septic Arthritis Research Articles

Humeral Shortening and Inferior Subluxation as Sequelae of Septic Arthritis of the Shoulder in Neonates and Infants

Humeral Shortening and Inferior Subluxation as Sequelae of Septic Arthritis of the Shoulder in Neonates and Infants

Management of sequelae of septic arthritis of hip

A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint.

Treatment of the late sequelae of septic arthritis of the hip.

Numerous salvage procedures have been proposed for the treatment of late sequelae of septic arthritis of the hip. Despite this, there are no reports in the literature discussing treatment with simultaneous hip reconstruction and femoral lengthening using the hybrid advanced Ilizarov method. The authors reviewed their experience with this technique, and present 15 patients treated between 1982 and 1997. The average age of the patients was 21.1 years and the average limb length discrepancy was 6.5 cm. All the hips were classified according to the classification of Choi et al. The time the external fixator was worn was 225.5 days and the average followup was 108 months. The results were classified based on pain relief, residual deformity, range of motion, Trendelenburg sign, and limb length discrepancy. Ten patients had a good or excellent result, three patients had a fair result, and only two patients had a poor result. Major complications included a common peroneal nerve palsy in one patient, loss of angulation of the proximal femoral osteotomy in two patients, and a mild knee subluxation in three patients all of whom responded to treatment. At the latest followup, 13 patients were satisfied with the treatment, all had returned to their previous occupations, and no patient had a total hip arthroplasty.

Long-term results of Charnley low friction arthroplasty in patients younger than 40.

We reviewed a consecutive series of 145 total hip arthroplasties that were performed between 1969 and 1983 in 113 patients under 40 years (mean age 33 years). Preoperative diagnosis was secondary osteoarthrosis in 49 hips, rheumatoid arthritis or ankylosing spondylos in 40, avascular osteonecrosis in 38, sequelae of septic arthritis in 6 and others in 12.All operations were performed in a standard operating room. A lateral approach was always used. Cemented implants were Charnley prosthesis (20) before 1973 and Charnley-Kerboull prosthesis (125) from 1973 to 1983.There were 2 delayed unions of the trochanter, 3 deep infections, 1 acute and 2 chronics. Recurrent dislocations due to excessive wear of the acetabular component were observed in 3 hips.At the most recent examination in 1994, 90 hips were reviewed, 48 hips had been lost to follow-up between 6 months and 15 years after surgery, 5 patients (7 hips) had died. The clinical and radiological results of the 137 hips followed up at least 2 years were available for the present study with a median follow-up period of 12 years (range 2 to 24 years). Of these 137 hips, 96 had been followed-up more than 10 years (mean 17 years, range 10 to 24 years).At the latest follow-up, the mean functional score in the d'Aubigné scoring system was 16,5 (range 8 to 18). There were 9 definite and 4 probable loosenings of the socket and 6 definite loosenings of the femoral component (5 subsidences and 1 fracture of the stem). The mean amount of the linear socket wear was 1,62 mm for the 137 hips and 2,22 mm for the 96 hips followed up more than 10 years. Cystic granulomatous lysis was observed in the acetabular area (14 hips), in the calcar (64 hips) and in other zones of the femoral cortex (16 hips). Heterotopic ossification was present in 43 hips.Of the initial 145 hips, 19 had been revised: 3 for septic loosening, 1 for fracture of the stem, 6 for excessive wear of the socket with periacetabular osteolysis and 9 for aseptic loosening (8 acetabular and 1 femoral component). Of these 19 revisions, 11 were performed after 10 years.According to these results the overall probability of retention of the prosthesis was 93,7 at 10 years, 81,5 % at 15 years and 77% at 20 years. When excluding the 3 revisions that were performed for septic loosening, the survival rate was 95,4% at 10 years, 84% at 15 years and 80% at 20 years.These results confirm that the long term reliability of total hip arthroplasty in young patients is less good than in older patients. The main cause of failure was aseptic loosening of the socket which was significantly correlated in this study with an excessive amount of wear. Nevertheless these results performed with a classical friction combination metal on polyethylene are similar or better than other reports with use of new friction combination as alumina-alumina. Further reseach will probably allow us to increase the wear resistance of total hip arthroplasty especially in young patients.Currently, the choices adopted in this series remain a good compromise for us that allow to expect good clinical and radiological results in more than 80% of the cases over 15 years.

Ankle arthrodesis with cross screw fixation. Good results in 36/40 cases followed 3-7 years.

Tibiotalar arthrodesis by an anterior approach, using internal compression with cancellous crews, offers wide exposure, good possibilities of correcting deformities, and good bony apposition. From 1987 to 1991, we used this technique in 42 ankle joints (40 patients). The indications were posttraumatic arthrosis, sequelae of septic arthritis, necrosis of the talus and failed ankle arthrodesis. In 13 ankles with severe deformity, a bone graft was also used. 38 patients (40 ankle joints) were available for follow-up after 4 (3-7) years. Solid union was achieved in 38 ankles after an average of 13 weeks. The clinical result was good-to-excellent in 36 ankles. We conclude tha this is a simple and effective method for ankle arthrodesis in both low-risk and, coupled with bone grafting, in properly selected high-risk patients.

Hip Reconstruction for Femoral Head Loss From Septic Arthritis in Children

Seven children (8 hips) with Choi's Type IV-B sequelae of septic arthritis of the hip underwent an unconventional reconstruction technique using a vascular-pedicled iliac crest graft to replace the destroyed femoral head and neck. The average age at surgery was 3.5 years, and the mean followup 7 years. Graft incorporation was observed in all patients; however, severe graft resorption was found in 1 hip, and mild resorption in 4 hips. The method of internal fixation of the iliac crest graft was not ideal and will require modification. Excellent femoral head-neck substitution with graft hypertrophy and remodeling was seen in 3 hips. In 7 hips (88%), vertical hip stability was achieved and a good range of hip motion was maintained. All children adapted very well to the operative procedures. At the final followup, the symptoms were those of limb-length discrepancy; pain was not a symptom.

Septic Hip in Pelvic Fracture with Urologic Trauma

Urologic injuries occur in 10% of pelvic fractures and hip sepsis is a rare complication. The symptoms of a septic hip are often not as dramatic when found in the setting of an acute pelvic fracture and may be overlooked. A case is presented with a review of the literature. Early recognition and aggressive surgical debridement are important to prevent the long-term sequelae of septic arthritis.

Late Sequelae of Septic Arthritis of the Hip in Infancy and Childhood

We report a multicenter long-term follow-up study of patients with septic arthritis of the hip during infancy or childhood. Group I ("infantile") consisted of patients with onset before age 3 months, and Group II ("childhood") consisted of patients in whom onset occurred after age 3 months. Patients were specifically examined for this review. Generally, patients at follow-up had poor anatomic appearance radiographically and scored poorly on the Harris rating system. However, pain and activity restriction were minimal. Patients who were not treated operatively tended to function better than patients who underwent operative reconstruction.

Septic arthritis in patients with sickle-cell disease.

The presenting features, modes of treatment and sequelae of septic arthritis of 50 joints in 31 Nigerians with sickle-cell disease were studied prospectively over a 66-month period. Most patients were in the second or first decade of life. Males predominated, and the hip was the commonest site of involvement. Infection was polyarticular in 39% and was associated with osteomyelitis in 84%. Most presented with a long history of local disease. The remainder were toxic and desperately ill patients in whom arthritis occurred later. Gram-negative infection predominated, and the commonest organism was Salmonella. Treatment was conservative in most cases, and arthrotomy was performed in only 12 joints. No deaths resulted, but severe complications occurred in 76%, apparently due to delay in diagnosis, severity of illness and a high incidence of hip-joint infection.

The prognostic significance of the triradiate cartilage in suppurative arthritis of the hip in infancy and early childhood.

The Journal of Bone and Joint Surgery. British volumeVol. 63-B, No. 2 ArticlesFree AccessThe prognostic significance of the triradiate cartilage in suppurative arthritis of the hip in infancy and early childhoodS Wientroub, GC Lloyd-Roberts, M FraserS WientroubSearch for more papers by this author, GC Lloyd-RobertsSearch for more papers by this author, M FraserSearch for more papers by this authorPublished Online:1 May 1981https://doi.org/10.1302/0301-620X.63B2.7217140AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByReferencesCase Reports: Treatment of Traumatic Triradiate Cartilage Epiphysiodesis: What is the Role of Bridge Resection?15 May 2013 | Clinical Orthopaedics and Related Research®, Vol. 471, No. 11Septic Arthritis of the Neonatal Hip: Acute Management and Late ReconstructionJournal of the American Academy of Orthopaedic Surgeons, Vol. 21, No. 10Infection4 October 2011Extra capsular extrusion of femoral capital epiphysis – an unusual presentation of sequelae of septic arthritis of hipJournal of Pediatric Orthopaedics B, Vol. 20, No. 6Osteochondroplasty of the femoral head in hip reconstruction for type II late sequelae of septic arthritis: a preliminary reportHazem Mossad El-Tayeby1 December 2008 | Journal of Children's Orthopaedics, Vol. 2, No. 6Acetabular Dome Retroversion: Radiological Appearance, Incidence and Relevance24 January 2018 | HIP International, Vol. 16, No. 3Pathomorphologic Characteristics of Posttraumatic Acetabular DysplasiaJournal of Orthopaedic Trauma, Vol. 14, No. 7BibliographyInfectionNeonatal and Infantile Septic ArthritisPelvis: Triradiate Cartilage Vol. 63-B, No. 2 Metrics Downloaded 97 times History Published online 1 May 1981 Published in print 1 May 1981 InformationCopyright © 1981, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Septic Arthritis in Children

When septic arthritis involves the hip, the prognosis is much worse than with any other joint. Approximately 50 per cent of the results were unsatisfactory with hip involvement compared to 12 per cent unsatisfactory results with involvement of the other joints. The erythrocyte sedimentation rate is a much more helpful diagnostic test than the leukocyte count or differential cell count. The most important prognostic factors are the duration of symptoms prior to treatment, a penicillinase-producing organism (penicillin-resistant) as the etiologic agent, and evidence of associated metaphyseal osteomyelitis. Early decompression and cleansing of the joint by aspiration or arthrotomy are essential for a good result. Long-term parenteral antibiotic therapy improves the prognosis when osteomyelitis is an assoicated feature. Arthrotomy with continuous irrigation appears to be more effective in decreasing long-term residual effects than arthrotomy alone. Almost all secondary surgical procedures are directed toward correcting the sequelae of septic arthritis of the hip.