Treatment of neonatal septic arthritis sequelae of hip: a case report

Late sequelae of osteoarticular infections in pediatric patients: A single-center study

To review the orthopedic sequelae of pediatric patients diagnosed with osteoarticular infections (OAIs) and identify significant differences between those with and without sequelae. Medical charts between 2010 and 2016 from a tertiary-care pediatric hospital were reviewed to collect demographic and clinical data for this retrospective case series. The main inclusion criteria were: 1. age (≤10 years old); 2. absence of sickle cell anemia and immunocompromising disease or medication; 3. a minimum follow-up of 12 months with radiographs; and 4. diagnosis of osteomyelitis of long bones and/or septic arthritis. The following late sequelae were observed and aggregated: osteal deformations that led to limb-length discrepancies (LLD) superior to 5 mm, abnormal articular angulations of more than 5°, and symptomatic chondropathies visible on imaging studies after 1 year. The patients were divided into 2 subgroups: with and without sequelae. Chi-Squared tests were used for categorical variables and Mann–Whitney U tests for continuous data to identify statistically significant differences between the 2 subgroups. Among 401 patients with osteomyelitis and/or septic arthritis, 50 (12.5%) were included (24 girls and 26 boys). There were 36 (72%) cases of osteomyelitis, 8 (16%) cases of septic arthritis, and 6 (12%) cases of combined infection (3 acute/subacute and 3 chronic cases). Five (10%) patients had orthopedic sequelae at the latest follow-up. The total duration of antibiotic treatment (P = .002), infectious disease follow-up (P = .002), and the presence of sequestra (P = .005) were significantly different between subgroups. There were no statistically significant differences between the 2 subgroups for the other variables, but some trends could be discerned. Only 4/50 patients developed a sequestrum, 2 of which were in the orthopedic sequelae subgroup. Furthermore, initial C-reactive protein (CRP) values were higher in the sequelae subgroup, as were the CRP values at hospital discharge. The orthopedic follow-up was also longer in the sequelae subgroup. Finally, the delay between the onset of symptoms and the beginning of antibiotic treatment was longer in the sequelae group. Patients with orthopedic sequelae had a longer antibiotic treatment and infectious disease follow-up, and were more likely to have presented with a sequestrum. Level of evidence: IV – case series.

The Pelvic Support Osteotomy After Type IVA Septic Arthritis of the Hip

Introduction:

A misdiagnose and inadequate treatment of neonatal septic arthritis of the hip has multiple sequelae and causes a severe disability. The aim of this study is evaluation of treatment of residual deformity after type IVA neonatal septic arthritis of the hip by Pelvic support osteotomy.

Case presentation:

A 11-year-old, white girl, was treated surgically by pelvic support osteotomy. The patient underwent two surgical interventions. The first operation consists in lengthening of the left femur for 6 cm with monolateral lengthening external fixation device. The second operation consists in pelvic support osteotomy of the left femur and lengthening for 4 cm. The limb was well aligned after healing, with the axis aligned under the medial wall of the acetabulum.

Conclusion:

Pelvic support osteotomy can successfully correct a Trendelenburg-Duchenne gait and simultaneously restore knee alignment and correct lower-extremity length discrepancy.