Clin Orthop Surg.  2015 Mar;7(1):110-119. 10.4055/cios.2015.7.1.110.

Prognostic Factors of Septic Arthritis of Hip in Infants and Neonates: Minimum 5-Year Follow-up

• Lee SC
• Shim JS
• Seo SW
• Lee SS

• KMID: 2069883
• DOI: http://doi.org/10.4055/cios.2015.7.1.110

Abstract

BACKGROUND
The authors conducted the present study to identify clinical and radiological prognostic factors in infants and neonates with septic arthritis of the hip.
METHODS
The authors retrospectively reviewed the records of 31 patients with septic arthritis of the hip. All of the patients were younger than 18 months old. Follow-up periods ranged from 5 to 17 years. The following potential variables for predicting the prognosis were included in the assessment: gender, age, underlying diseases, duration of symptoms, changes of hip joint in X-ray, concomitant osteomyelitis, elevation of erythrocyte sedimentation rate and C-reactive protein, sepsis, pus drainage, synovial fluid culture, and infecting organisms. Clinical and radiological prognoses were analyzed at the final follow-up.
RESULTS
Univariate analysis demonstrated that radiological prognoses were poorer in patients who had underlying diseases, a longer duration of symptoms, and pus drainage. However, on multivariate analysis, only the variable-duration of symptoms-was found to be statistically related with a poor radiological prognosis.
CONCLUSIONS
Although poor prognosis for patients with several underlying diseases and radiological changes has already been established, a favorable outcome might be expected with prompt surgical drainage and appropriate antibiotics.

Keyword

Septic arthritis; Hip; Infant; Neonate; Prognosis

MeSH Terms

Arthritis, Infectious/*diagnosis/microbiology/therapy
Female
Follow-Up Studies
*Hip Joint
Humans
Infant
Infant, Newborn
Male
Prognosis
Retrospective Studies

Figure

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  Fig. 1 Box plots of symptom duration before operation between groups. The arrow denotes the average days of each group. (A) Satisfactory and unsatisfactory groups. (B) Radiological grade by Bennett and Namnyak9): excellent, good, fair, and poor.

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  Fig. 2 Logistic regression analysis showing the relations between duration of symptoms before the operation and radiological prognosis. The line is the curve fit from logistic regression, and represents the probability of an unsatisfactory radiological prognosis with the duration of symptoms before the operation. If the duration of symptoms before the operation is 2.53 days, the patient has an unsatisfactory radiological prognosis in 25% of cases; 4.72 days, in 50% of cases; 6.9 days, in 75% of cases; and 13.84 days, in 99% of cases.

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  Fig. 3 A ten-day-old boy born on the 28th week of gestation and weighing 650 g was treated for septic arthritis of the right hip by prompt surgical drainage and antibiotics 5 days after symptoms developed. He also had congenital heart disease and respiratory distress syndrome. (A) Preoperative plain radiograph of the hip joint showed soft tissue swelling (arrows). (B) Radiograph of pathologic dislocation of the femoral head at age 3 years (arrows). (C) He underwent open reduction, varizational and derotational osteotomy of the proximal femur, and trochanteric arthroplasty (arrows). (D) At age 10 years, flexion of the right hip was limited to 90°, and the clinical result was fair and radiological grade was poor.

Reference

1. Belthur MV, Palazzi DL, Miller JA, Phillips WA, Weinberg J. A clinical analysis of shoulder and hip joint infections in children. J Pediatr Orthop. 2009; 29(7):828–833.

2. Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequelae and reconstruction after septic arthritis of the hip in infants. J Bone Joint Surg Am. 1990; 72(8):1150–1165.

3. Kabak S, Halici M, Akcakus M, Cetin N, Narin N. Septic arthritis in patients followed-up in neonatal intensive care unit. Pediatr Int. 2002; 44(6):652–657.

4. Kang SN, Sanghera T, Mangwani J, Paterson JM, Ramachandran M. The management of septic arthritis in children: systematic review of the English language literature. J Bone Joint Surg Br. 2009; 91(9):1127–1133.

5. Chen CE, Ko JY, Li CC, Wang CJ. Acute septic arthritis of the hip in children. Arch Orthop Trauma Surg. 2001; 121(9):521–526.

6. Nunn TR, Cheung WY, Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg Br. 2007; 89(1):100–106.

7. Shaw BA, Kasser JR. Acute septic arthritis in infancy and childhood. Clin Orthop Relat Res. 1990; (257):212–225.

8. Klein DM, Barbera C, Gray ST, Spero CR, Perrier G, Teicher JL. Sensitivity of objective parameters in the diagnosis of pediatric septic hips. Clin Orthop Relat Res. 1997; (338):153–159.

9. Bennett OM, Namnyak SS. Acute septic arthritis of the hip joint in infancy and childhood. Clin Orthop Relat Res. 1992; (281):123–132.

10. Morrey BF, Bianco AJ Jr, Rhodes KH. Septic arthritis in children. Orthop Clin North Am. 1975; 6(4):923–934.

11. Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005; 6(1):2–8.

12. Merle D'Aubigne R. Numerical classificaion of the function of the hip: 1970. Rev Chir Orthop Reparatrice Appar Mot. 1990; (76):371–374.

13. Caksen H, Ozturk MK, Uzum K, Yuksel S, Ustunbas HB, Per H. Septic arthritis in childhood. Pediatr Int. 2000; 42(5):534–540.

14. Howard JB, Highgenboten CL, Nelson JD. Residual effects of septic arthritis in infancy and childhood. JAMA. 1976; 236(8):932–935.

15. Morrey BF, Bianco AJ, Rhodes KH. Suppurative arthritis of the hip in children. J Bone Joint Surg Am. 1976; 58(3):388–392.

16. Obletz BE. Acute suppurative arthritis of the hip in the neonatal period. J Bone Joint Surg Am. 1960; 42(1):23–30.

17. Al Saadi MM, Al Zamil FA, Bokhary NA, Al Shamsan LA, Al Alola SA, Al Eissa YS. Acute septic arthritis in children. Pediatr Int. 2009; 51(3):377–380.

18. Wang CL, Wang SM, Yang YJ, Tsai CH, Liu CC. Septic arthritis in children: relationship of causative pathogens, complications, and outcome. J Microbiol Immunol Infect. 2003; 36(1):41–46.

19. Yamagishi Y, Togawa M, Shiomi M. Septic arthritis and acute hematogenous osteomyelitis in childhood at a tertiary hospital in Japan. Pediatr Int. 2009; 51(3):371–376.

20. Young TP, Maas L, Thorp AW, Brown L. Etiology of septic arthritis in children: an update for the new millennium. Am J Emerg Med. 2011; 29(8):899–902.