Two-stage total hip arthroplasty for chronic septic hip arthritis / 中华创伤骨科杂志

Objective:To analyze the clinical efficacy of two-stage total hip arthroplasty in the treatment of chronic septic hip arthritis.Methods:From January 2008 to March 2020, 17 patients with chronic septic hip arthritis (17 hips) received two-stage total hip arthroplasty at Department of Orthopaedic Surgery, The First Affiliated Hospital to of Fujian Medical University. They were 11 males and 6 females, with an average age of 54.5 years (from 19 to 77 years) and 9 left and 8 right hips affected. There were 10 cases of primary septic hip and 7 cases of secondary infection after hip surgery. Three patients had undergone debridement in other hospitals and one patient had developed a sinus tract. In the first stage operation, the diseased femoral head and neck were resected to implant an articulating spacer after thorough debridement; in the second stage operation, the spacer was removed to implant a uncemented artificial hip prosthesis in 16 cases or a cemented artificial hip prosthesis in one case. Recorded were the results of microbial culture, operation time, intraoperative blood loss, and therapeutic outcomes of the patients.Results:Pathogenic data were available in 13 patients and the culture was negative in 4. The pathogens were detected by metagenomic next-generation sequencing in 2 patients with culture negative. In the first stage operation, operation time averaged 140.6 min (from 90 to 176 min) and intraoperative blood loss 361.8 mL(from 100 to 1 000 mL); in the second stage operation, operation time averaged 130.3 min (from 91 to 166 min)and blood loss 291.2 mL(from 50 to 700 mL). The average interval between the first and the second stage operations was 115.0 days(from 66 to 227 d). During the interval, spacer fracture occurred in one case, spacer dislocation in one case and lower extremity deep venous thrombosis in one case. All the patients were followed up for 12 to 82 months (average, 36.7 months) after second stage operation. The inflammatory indexes decreased to normal in all the 17 patients and infection recurrence was observed in none of them.Conclusions:Two-stage total hip arthroplasty may result in a high rate of successful treatment of chronic septic hip arthritis. Specific use of sensitive antibiotics after identification of specific pathogenic microorganisms by multiple methods is the key to a successful treatment.

Septic Arthritis of the Hip Joint after Pelvic Radiotherapy in Patients with Cancer: Case Report

Septic arthritis of the hip joint after radiotherapy is a rare complication with distinctive features. It is difficult to recognize this complication because of its late onset and lack of significant fever. We describe three cases of patients with septic arthritis in the hip joint who had a history of radiotherapy in the pelvic region. Our patients developed septic arthritis 1, 2, and 3 years after radiotherapy and these occurrence intervals were relatively shorter when compared to previous literature. Hip joint destruction was noted in all cases. Resection of the femoral head was required to control the infection in two cases. Careful attention is requested to detect septic arthritis when patient experiences pain in joint where underwent radiotherapy. For this case, prompt laboratory study, radiological evaluation, and joint fluid aspiration and culture are required. If there is evidence of infection in these results, a proper and immediate treatment must be started.

Septic Hip Arthritis with Iliopsoas Abscess Detected after Spine Operation: A Case Report / 대한고관절학회지

In the elderly patients who complain of pain in the buttock and leg, it is not easy to distinguish whether the pain comes from the lesion of the hip or from the spine. A 78-year-old female who was treated conservatively for persistent pain in the right buttock and leg after an operation for spinal stenosis in the local clinic visited our clinic. Septic hip arthritis with severe femoral head destruction and multiple abscesses in the buttock and iliopsoas muscle were diagnosed 2 months postoperatively, and spinal abscess in the site of the previous operation was detected by a subsequent MRI study. To avoid such a delay of the diagnosis and treatment, it is important to suspect hip joint lesion earlier for the source of persistent pain after a spine operation. Further more, diagnostic evaluation is necessary to rule out co-infection of the spine or iliopsoas muscle when a hip joint infection exists.

MRI in Suspected Acute Septic Arthritis of the Hip Joint in Children / 대한고관절학회지

PURPOSE: The purpose of this study is to assess the usefulness of magnetic resonance imaging (MRI) in diagnosis, planning of treatment methods for suspected acute septic arthritis in children, and evaluation of the clinical results of the operations with the help of magnetic resonance imaging as a diagnostic modality. MATERIALS AND METHODS: Between March 2003 and May 2007, 20 patients suspected of having acute septic arthritis of the hip underwent MRI. The mean age of the patients was 3 years and 5 months (range: 10 days-14 years). The average follow-up was 2 years and 2 months (range: 1 year-3 years 6 months). Assessment of MRI findings and final results with recurrence of the infection and post-infectious radiographic sequelae was performed retrospectively. RESULTS: Among the 20 cases, 17 cases(85%) showed joint effusion. Among these 17 cases, accompanying signal changes were observed in the meta-epiphyseal region in seven cases, and accompanying signal changes were observed in surrounding soft tissue in three cases. Accompanying abscess formation was observed in one case. The remaining three cases(15%), which had no joint effusion, showed an intramuscular abscess pocket around the joint, which mimicked septic arthritis. At final follow up, two cases showed unsatisfactory results, with limited joint motion and radiographic sequelae. CONCLUSION: In children who are suspected of having acute septic arthritis of the hip, MRI can provide useful information about the location and extent of infection and even the differential diagnosis of acute septic arthritis. MRI was considered to be a useful method for diagnosis of suspected acute septic arthritis in children.

Contemporary Alumina-on-Alumina THA in Patients with Sequelae of the Hip Joint Infection / 대한정형외과학회잡지

PURPOSE: THA in patients with dysplastic hips secondary to infection of the hip joint is a technically challenging procedure because of long-standing anatomic abnormalities of the bone and soft tissues. Low friction, low wear, alumina-on-alumina bearing surfaces are an attractive alternative to conventional metal-on-polyethylene articulation, and may offer a promising option for young, active patients. Here, we evaluated the results of a modern alumina-on-alumina THA performed in patients with sequelae of the hip joint infection, with a 5-year minimum follow-up. MATERIALS AND METHODS: We retrospectively analyzed 48 primary cementless alumina-on-alumina THAs that had been performed in patients who had sequelae of the hip joint infection between November 1997 and December 2000. The average age of the patients at the time of the index arthroplasty was 36.7 years (range, 18-63 years) and41 patients were younger than 50 years old. They were followed-up for more than 5 years (average, 82 months range, 60-103 months). RESULTS: All hips had no recurrence of a hip joint infection. The mean Harris hip score improved from 61.6 points preoperatively to 92.2 points at the latest follow-up. All of the implants had radiographic evidence of bone ingrowth and no radiological loosening. During the follow-up period, nocup or stem was revised. Periprosthetic osteolysis was suspected in one hip. Leg length discrepancy was corrected from 26.2 mm preoperatively to 9.5 mm postoperatively. Postoperatively, the hip center migrated 11.7 mm medially and 5.2 mm inferiorly. Nonunion of the osteotomized greater trochanter occurred in two hips, but no postoperative infection or ceramic failure was observed. CONCLUSION: The 5-year minimum follow-up clinical results of modern alumina-on-alumina THA in patients with sequelae of the hip joint infection were encouraging. Our results show that alumina-on-alumina articulation offers a reliable alternative solution for young patients with technically difficult arthroplasties.

Colonna Greater Trochanteric Arthroplasty for Septic Hip Sequelae: Long-term Follow-up of Two Cases / 대한정형외과학회잡지

Hip dislocation and associated instability in septic hip arthritis, caused by destruction of the femoral head and neck and damage of the proximal femoral epiphysis, is difficult to treat. Colonna greater trochanteric arthroplasty, which places the greater trochanter into the acetabulum, can provide stability and increased function in the hip joint. The greater trochanter can be remodelled to act as a femoral head. We report 2 cases of Colonna greater trochanteric arthroplasty, which were observed twelve and twenty years after surgery. Although the patient had limited motion of the hip joint, which was accompanied by pain and limping, the overall results were satisfactory. In summary, we believe that Colonna greater trochanteric arthroplasty is an effective way of achieving a stable hip joint in a difficult septic hip sequelae. Limb length discrepancy can be corrected by a limb lengthening procedure at a later stage. In addition, conversion to a total hip arthroplasty is much easier than in unreduced high dislocation.

Treatment of the Pyogenic Arthritis of Hip in Neonates and Infants / 대한정형외과학회잡지

Septic arthritis of hip is a serious problem. Delay in diagnosis and treatment can results in crippling. From September 1983 to May 1993, we have experienced 17 cases of pyogenic arthritis of the hip in neonates and infants. Ten cases were under the age of 1 month old, four were from 1 month to 2 months, and the rest of 3 cases were 11 months old with depicting high incidence in neonates within 1 month. Laboratory findings according to lag periods were as follows; The patients group (n=9) who visited within 3 days after symptom onset manifested high fever (over 38oC) in 2 cases only and 7 cases revealed normal or mild fever. The patients group (n=8) being seen later than 3 days showed high fever in most of cases. Leukocytosis was mostly unspecific in both groups. The average WBC counts tested on admission were 16,052/mm3, ESR 38.3mm/hr,and WBC count dropped to 11,264/mm3, ESR to 27.3 mm/hr after operation. Microbial culture was positive in 10 cases (58.8%), of which 4 were staphylococcus, 5 were streptococcus and 1 was ancinetobacter. Surgical drainage was done through the posterior approach. Long term follow up showed no recurrence and severe complications such as dislocation of head, avascular necrosis and osteomyelitis of proximal femoral metaphysis In conclusion, pyogenic arthritis of hip occurred more common in neonates less than month old and laboratory findings were not always accompanied by fever and hematologic changes especially when the symptom onset was less than 3 days.

Treatment of the Sequelae of Septic Hip in children: Report of 2 Cases / 대한정형외과학회잡지

Septic arthritis of the children's hip causes acute or chronic inflammatory change in structure about the joint, and results in serious destruction. Due to recent advance of the diagnostic technique and of the antibiotics, the incidence of it's sequelae is decreased. The management of acute stage with antibiotics and early surgical drainage has been well established in the literature, but the management of residual anatomic deformity is less documented, and little comprehensive classification or treatment program has been outlined. We experienced two patients who had sequelae induced by delayed diagnosis and improper treatment. One had a complete loss of femoral neck with femoral head remaining in the acetabulum. Femoral neck reconstruction was performed using proximal femur : i.e., Open reduction of femoral head to femur shaft with distal transfer of greater trochanter (1st stage) followed by varus osteotomy(2nd stage) and follow-up period was 3.5 years. Another had loss of femoral head and neck, dislocation of the hip, and Larsen's trochanteric arthroplasty was performed with 6 Years follow-up. Satisfactory results were obtained in both patients who had reconstructive surgery, so we report these cases with related literatures.

Our Experience with Steel's Triple Innominate Osteotomy On Paralytic Hips and Septic Hip Residua / 대한정형외과학회잡지

In 1973, Steel described triple innominate osteotomy in which the ischium, the superior pubic ramus and ilium superior to the acetabulum are divided and the acetabulum is repositioned anterolaterally and is stabilized by a bone graft and metal pins. Its goal is to establish a stable hip for dislocation or subluxation of the hips in older children and adults on whom it is impossible to correct effectively the instability by any one of the more conventional osteotomies, i.e. Salter's, Pemberton's or Chiari's, or by the capsular arthroplasty of Colonna. During the eleven years and eight months, from December 1973 to August 1985, at the Department of Orthopedic Surgery, Seoul National University Hospital, we performed Steel's triple innominate osteotomy on 41 cases, of which 37 were residual poliomyelitis and 4 septic hip residua. 4 cases of residual poliomyelitis were lost during follow up. The remaining 37 cases were reviewed for the efficacy and limitations of triple innominate osteotomy. We observed following conclusions: 1. Aside from congenital dislocation and dysplasia of the hip, paralytic conditions, such as residual poliomyelitis, are good indications of Steel's triple innominate osteotomy in older children, adolescents and young adults. Acetabular acclivity is adequately reduced and stability is improved. 2. Septic hip residua, including healed tuberculosis, is another indication of triple innominate osteotomy, particularly when total hip arthroplasty is contemplated. 3. When abductors are partially paralyzed, triple innominate osteotomy alone results in appreciable increase in abductor power, by providing a better muscle tension. 4. Substantial gain in leg length is an added advantage of triple innominate osteotomy. An average of 1.74 cm was gained at osteotomy site in our series. In adults, when limb shortening is relatively m i nor, triple innominate osteotomy alone can be a more convenient alternative to conventional, more formidable method of leg length equalization, such as femoral lengthening. This is particularly true when there is some instability or when abductors are weak. 5. Following improvement in mechanical stability by triple innominate osteotomy, weak abductors and extensors may be augmented by appropriate muscle transfer, resulting in more stable hip functionally. 6. In a hypermobile paralytic hip, iliopsoas tenotomy is neither necessary nor desirable at the time of osteotomy. When the hip is dislocated, or when the hip has marked flexion deformity, iliopsoas tenotomy fascillitates adequate correction, but this greatly increases the risk of neurological complication.