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 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.

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.