Management of post septic sequelae of hips with dislocation in children
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ORIGINAL PAPER
Management of post septic sequelae of hips with dislocation in children Prateek Rastogi 1 & Anil Agarwal 1 Received: 1 May 2020 / Accepted: 16 July 2020 # SICOT aisbl 2020
Abstract Background Limited literature guide management of post septic sequelae of hips with dislocation in children. We studied the functional and radiological outcome of open reduction of such sequelae in 11 children. Special emphasis was given to determine the influence of surgical correction and relocation of these hips. Methods Preoperative acetabular index (AI) on both sides was compared to quantify acetabular dysplasia. Radiological parameters like AI, centre edge angle (CEA), Reimer’s index, centre head distance discrepancy (CHDD) and neck shaft angle (NSA) were calculated and compared with the unintervened side at follow-up. Outcome was assessed radiologically by modified Severin classification and clinically by Moon’s criterion. Results Average age at open reduction was 20.6 months and further follow-up was 48.8 months. The mean pre-operative AI on intervened side (35 degrees) differed significantly from unintervened side (22.5 degrees). The follow-up AI on intervened side (26.5 degrees) improved significantly from the pre-operative values but residual dysplasia persisted. Mean values for other radiological parameters on intervened side at follow-up were CEA 16.1 degrees, Reimer’s index 31.5%, CHDD 18.6% and NSA 119 degrees. Mean shortening of 2.3 cm was documented in ten patients at final follow-up. Triradiate cartilage fused in four out of 11 hips at follow-up. Radiological outcome according to modified Severin classification was good to fair in seven patients (types II and III) whereas poor in four patients (types IV and V). Functional outcome as per Moon’s criterion was excellent to good in nine patients, fair and poor in one patient each. Conclusions Open reduction potentially alters the natural history of post septic sequelae of hips with dislocation and contributes to better hip mechanics and function. Keywords Sepsis . Hip . Children . Dislocation . Sequelae
Introduction Septic arthritis of the hip joint is a serious condition which can lead to grave immediate as well as long-term unfavourable outcomes. The difficulty in locating site and the absence of inflammatory signs can make the diagnosis more difficult in infants and thus many present as late sequelae [1–3]. The
Not presented anywhere * Anil Agarwal [email protected] Prateek Rastogi [email protected] 1
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
sequelae can vary from being completely asymptomatic detected as an incident finding or at the other end of spectrum, there can be gross restriction of joint movements and severe functional incapabilities. Radiological findings may similarly range from minimal irregularities of the joint to arthritic changes, arthrodesis or loss of femoral head [1–3]. While other patterns of sequelae have been described by many authors, dislocation of
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