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  • Title: [Management of early symptoms of acute septic hip in neonates and infants--conservative or surgical?].
    Author: Lipczyk Z, Niedzielski J, Midel A, Król R.
    Journal: Chir Narzadow Ruchu Ortop Pol; 2001; 66(5):429-34. PubMed ID: 11875874.
    Abstract:
    The paper presents 41 cases of acute hip sepsis in 36 patients, age ranging from 5 to 66 days. 32 cases were treated at the Institute of Polish Mother Hospital and 4 at the Pediatric Surgery Department of the Medical School of Łódź. In 40% of the cases multifocal infections were noted. Septic arthritis was diagnosed basing on clinical symptoms, lab tests, ultrasound screening, X-rays and immunoglobulin scyntigraphy. Patients were divided into three groups according to treatment: group 1 was administered antibiotics and immobilization was applied (16 patients--19 hips), group 2 had a biopsy, was administered antibiotics and immobilization (5 patients--6 hips), group 3 had an arthrotomy performed, wound drainage, casting was applied and antibiotics were administered (15 patients--16 hips). Immobilization was maintained by means of a cast or Koszla's harness. Patients were qualified for surgery basing on ultrasound investigation. After completion of various modes of treatment patients were followed at the outpatient clinic of the orthopedic department. A complete assessment was performed 3-6 years after the first symptoms appeared. A full clinical examination (ROM assessment), X-ray investigations were performed. Hip dysfunction was assessed basing on X-ray images according to the Ho Choi classification. Conservative treatment seems to be sufficient in early stages of septic arthritis, with only minor morphological pathologies visible on ultrasound examination. Early arthrotomy seems to be the method of choice in septic arthritis treatment. Aspiration of the hip may not be possible due to solid consistency of pus.
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