Septic arthritis of the hip in infancy: end result study.

Twenty-four hips in 21 patients suffering septic arthritis at infancy were followed 11-30 years (mean 17 years). Fourteen hips with none to moderate femoral head destruction proved to have a fairly good chance of becoming located following closed treatment. If it failed, open reduction was successful, provided the femoral head-neck was big enough to achieve a stable reduction. Out of the 10 hips with absent femoral head-neck and an iliac dislocation, 6 underwent trochanteric arthroplasty: 3 hips remained located though with limited motion, and one of the 3 became painful requiring arthrodesis. Two redislocated and one subluxated. Following infantile septic arthritis, the proximal femur may remain cartilaginous during the first years of life. Arthrography did not prove helpful in evaluating the hip damage, nor the remnant bone stock. During this stage, push-pull X-rays seemed the most reliable method to assess joint location. Only surgical exploration gave a definite evidence of the amount of hip destruction. If the hip persists unstable after the septic process is well under control, surgical exploration is indicated, at about one to 2 years of age. Open reduction should be performed if there is sufficient head-neck to achieve a stable reduction. Otherwise, a trochanteric arthroplasty seems the procedure of choice followed by a varus osteotomy if there is progressive subluxation. If successful, it will provide a stable joint, less length discrepancy and a limited motion which seems preferable than accepting a high iliac dislocation. It will also offer a better anatomical condition for joint replacement, if indicated at a later age.