Childhood hip sepsis: improving the yield of good results.

With the increasing availability of well-trained orthopaedic surgeons and pediatricians, early diagnosis and effective treatment of hip sepsis is now common. Despite these advances, poor results still occur. The principle of early surgical drainage and appropriate antibiotics must continue to be emphasized. Empiric surgical drainage in cases with equivocal aspiration results is advised. Postsurgical residual subluxation remains a significant problem in subacute cases with preoperative subluxation (lateralization) and is best avoided by an anterior approach for drainage, which can include adductor or psoas release, or both, followed by cast positioning of the hip to maintain reduction. Careful and thoughtful application of the recently accepted concept of early transition to oral antibiotics can significantly reduce the psychological and economic cost of hip sepsis treatment. Hip sepsis occasionally occurs in juveniles, adolescents, and teen-agers. Because of a low index of suspicion in this age group, diagnosis and treatment are often greatly delayed resulting in a poor outcome in many patients.