Evaluation of the modified Albee arthroplasty for femoral head loss secondary to septic arthritis in young children

Septic sequelae of hip in children: long-term clinicoradiological outcome study

The presented retrospective study is a report of 18 patients (23 hips) with infantile post sepsis hip sequelae. There were two groups of patients. The observation group comprised of 6 patients (8 hips). The intervention group included 12 patients (15 hips) of which 12 hips had been surgically intervened for the sequelae and 3 contralateral hips which were again serially observed. The sequelae hips were classified by Choi's radiological types. The clinical evaluation was done by modified Moon's criteria. The average patient age at follow-up was 9.3 years. There were 3 type I (13%), 10 type II (43%), 2 type III (8%), and 8 Choi type IV (35%) at presentation. The Choi radiological type showed propensity to change over time/following intervention. At follow-up, there 3 type I (13%), 17 type II (74%), and 3 type IV (13%) hips. At follow-up, there were seven excellent, seven good, and four fair results. The observation group had mostly type I or II and intervention group IIIB or IV Choi types. Findings common to both groups: same Choi radiological type fared different clinically, multiple joint involvement contributed to deterioration of function and late changes in acetabulum or proximal femur lead to deterioration of clinical function. The sequelae of septic hips likely to be kept under supervised observation were Choi type I or II. In select types, intervention changed the natural history of septic sequelae significantly.

Sequelae of pediatric osteoarticular infection

The epidemiology and diagnosis of osteoarticular infections (OAI) have changed considerably in recent years, partly due to the development of molecular biology. Kingella kingae is now recognized as the most frequent pathogen in children under 4 years of age, while methicillin-resistant Staphylococcus aureus (SA) has been increasingly reported. Although the clinical course of OAI is mostly benign, with shorter antibiotic regimens and simplified treatments, serious functional impairments and life-threatening complications can still occur, especially in case of delayed diagnosis or infection caused by Panton-Valentine leukocidin-producing strains of SA. Newborns and patients with sickle cell disease have greater risk of orthopaedic sequelae, which need to be detected and managed early. The main sequelae of osteomyelitis are angular limb deformity, due to partial growth arrest, and lower limb discrepancy. Therapeutic options are guided by the patient's age and predictions at maturity. The main complications of septic arthritis are joint stiffness and osteonecrosis. The procedures to consider are arthrodesis, joint reconstruction in immature children, and arthroplasty at the end of growth.

Long-term result after femoral head substitution in postinfectious aplasia of the femoral head

PURPOSE

This case report presents a new and unique surgical greater trochanter split procedure for reconstructing a hip joint after an infantile hip sepsis with consequent aplasia of the femoral head.

METHODS

One patient underwent the new trochanter split osteotomy for postinfectious aplasia of the femoral head at the age of 4 years. A follow-up of 17 years is presented.

SURGICAL TECHNIQUE

The remaining proximal femur is sagittally split and the medial part is shifted into the acetabulum, preserving the lateral part of the greater trochanter. The osteotomy is fixed by an osseous wedge and K-wires. In contrast to the techniques known so far, it does not harm the vastogluteal muscle sling, thus, significantly reducing abductor lurch. Furthermore, through placing juvenile growth cartilage from the greater trochanter area into the acetabulum, there is, by far, more potential for the regeneration of a femoral head than by the procedures known so far.

CONCLUSION

The presented surgical technique is able to improve the biomechanics of a hip joint with postinfectious aplasia of the femoral head. The growth of a new femoral head and the development of a well-shaped acetabulum is enabled. A clinical outcome with a stable joint and very good clinical function can be achieved.

Evaluation of the modified Albee arthroplasty for femoral head loss secondary to septic arthritis in young children: surgical technique

BACKGROUND

Surgical treatment options for femoral head deficiency in infants secondary to septic arthritis of the hip are varied and associated with uncertain long-term outcomes. The modified Albee arthroplasty has been considered an acceptable procedure; however, the long-term outcomes of this procedure have not been reported, to our knowledge. We evaluated the long-term outcomes of the modified Albee arthroplasty in young patients with severe sequelae of septic arthritis of the hip.

METHODS

We retrospectively studied twenty-one children (twenty-one hips) in whom Choi type-IVB sequelae of septic arthritis of the hip had been treated with a modified Albee arthroplasty and six patients with the same sequelae who had been managed with simple observation. The Trendelenburg sign, pain, the range of motion, hip function, the Harris hip score, and limb-length discrepancy were assessed clinically. Remodeling of the femoral head, hip stability, and arthritic changes in the hip were evaluated radiographically.

RESULTS

The twenty-one patients with the modified Albee arthroplasty were followed for an average of 121.2 ± 38.6 months and had better outcomes, in terms of the Trendelenburg sign, the Harris hip score, pain, the hip range of motion, and limb-length discrepancy, than the six patients who underwent simple observation. Patients who were two years of age or younger at the time of the arthroplasty exhibited a significantly less severe limb-length discrepancy and less loss of motion than those who were older than two at the time of the surgery. Furthermore, limb-length discrepancy was positively correlated and the range of motion of the hip and the Harris hip scores were negatively correlated with the patient's age at the time of the surgery, suggesting that early surgery in patients with severe sequelae of septic arthritis of the hip is associated with a better clinical outcome.

CONCLUSIONS

The modified Albee arthroplasty is a feasible and clinically useful procedure for the treatment of severe sequelae of septic arthritis of the hip, particularly in children who are two years of age or younger.