Differentiating Lyme arthritis: a case-based review.

The incidence or prevalence of Lyme arthritis (LA) in Denmark is unknown and assumed very low. No published cases of polymerase chain reaction (PCR)-confirmed LA from Denmark exist. Clinically, LA does not differ from other rheumatic oligoarthritic disorders posing a differential diagnostic challenge. To review the incidence and prevalence of LA to our knowledge and to present a case series of PCR-confirmed LA cases from Denmark. We conducted a systematic literature review via MEDLINE and EMBASE to explore incidence and prevalence rates of LA. Additionally, we present six cases of patients diagnosed with LA in Denmark. Our literature review identified 23 studies reporting prevalence or incidence, yet only ten studies provided estimates ranging from 1.1 to 280/100.000 in the general population. Our case series identified six patients with LA from a localized region in Southern Denmark; all confirmed by Borrelia-specific real-time PCR from synovial fluid. The diagnostic delay was up to 38 months. All patients except one had a history of previous tick bites; none had erythema migrans lesions. All presented with recurrent arthritis in the knee joint, and two had arthritis in the wrist. The literature review showed an incidence of LA ranging from 1.1 to 15.8 per 100.000 in Europe. Our case series suggests a potentially higher prevalence of LA in Denmark than previously believed. Lack of tick exposure history, antibody assessments and test of Borrelia burgdorferi sensu lato DNA in synovial fluid might lead to misdiagnosed cases potentially explaining the assumed low incidence of LA in Denmark.

Artritis séptica de rodilla por Serratia marcescens en paciente con hemofilia A

Presentamos el caso de un paciente varón de 24 años con hemofilia A de 14 años de evolución. El paciente presentó hemartrosis recurrente en rodilla derecha, luego desarrolló artritis séptica en dicha articulación producida por Serratia marcescens con respuesta satisfactoria al lavado intra-articular con solución salina y 28 días de tratamiento con carbapenémicos. En pacientes con artritis séptica, hemartrosis previa y múltiples ingresos hospitalarios debe sospecharse la presencia de este germen. El tratamiento es quirúrgico y con antibióticos de amplio espectro.

We present the case of a 24-year-old male patient with hemophilia A of 14 years of evolution. The patient presented recurrent hemarthrosis in the right knee, who developed septic arthritis in knee due to Serratia marcescens with a satisfactory response to intra-articular lavage with saline solution and 28 days of treatment whith carbapenems. In patients with septic arthritis, previous hemarthrosis and multiple hospital admissions, the presence of this germ should be suspected. The treatment is surgical and with broad spectrum antibiotics.

A case report of suppurative acromioclavicular arthritis and literature review / 中华骨科杂志

One case of suppurative acromioclavicular arthritis caused by Staphylococcus aureuswas reported. The patient was admitted to hospital due to swelling and pain in the right shoulder, limited mobility without no obvious cause.Through medical history, physical examination, imaging examination, and local tissue bacterial culture, it was confirmed that the infection was caused by Staphylococcus aureus. After surgery and anti infection treatment, satisfactory treatment results were achieved. Through literature review, 95 cases of suppurative acromioclavicular arthritis were retrieved and analyzed from 57 articles.Among them, 26 cases (27%) were infected with Staphylococcus aureus, including 3 cases of clearly identified methicillin-resistant Staphylococcus aureus, 2 cases of methicillin-sensitive Staphylococcus aureus, and 1 case of methicillin-resistant Staphylococcus epidermidis; 13 cases (14%) of Streptococcus; There were 6 cases (6%) of special pathogens, including 2 cases of Haemophilus parainfluenzae, 1 case of Candida, 1 case of Bacillus pallidum, 1 case of Mycobacterium avium, and 1 case of Pasteurella multocida; 50 cases (53%) of specific infections with pathogens were not clearly reported. Suppurative acromioclavicular arthritis has the characteristics of difficult early diagnosis, rapid disease progression, and strong destructiveness. MRI and ultrasound have high specificity and sensitivity in the diagnosis of this disease, and ultrasound can assist in obtaining joint fluid for examination. Early identification of the pathogen is the key to the treatment of this disease. Before identifying the pathogen, antibiotics should not be used arbitrarily. After diagnosis, timely anti infection treatment should be carried out, and if necessary, surgical debridement should be performed. The vast majority of patients can achieve satisfactory and accurate treatment results after active and standardized treatment.

Comparison of MR Findings between Patients with Septic Arthritis and Acute Gouty Arthritis of the Knee.

Purpose: To compare the MR findings of septic and acute gouty arthritis of the knee joint. Materials and Methods: This retrospective study included patients who underwent knee MRI for septic or gouty arthritis at our hospital between October 2012 and October 2018. The MR findings were analyzed for the presence of bone marrow edema, soft tissue edema, abscess, pattern of synovial thickening (frondlike, lamellated, diffuse linear), maximum thickness of the synovium, and joint effusion volume. The gouty (n = 5) and septic arthritis (n = 10) groups were compared using the Wilcoxon rank-sum test and Fisher's exact test. Results: No statistically significant differences were observed for each item. One patient in the gouty arthritis group and seven in the septic arthritis group had bone marrow edema. Soft tissue abscess formation was only observed in the septic group. The incidence of each synovial thickening pattern was as follows: 100% (diffuse linear) in the gouty arthritis group and 20% (frondlike), 50% (lamellated), and 30% (diffuse linear) in the septic arthritis group. Conclusion: Differentiation of gouty arthritis and septic arthritis based on imaging findings is difficult. However, lamellated synovial thickening patterns, bone marrow edema, and soft tissue abscess formation are more commonly observed in patients with septic arthritis than in those with gouty arthritis.

COVID-19-associated arthritis: an emerging new entity?

The current COVID-19 pandemic raises several clinical challenges. Cases of COVID-19-associated arthritis have been reported, and inconsistently described as either COVID-19 viral arthritis or COVID-19 reactive arthritis. We aimed to review all the reported cases of 'COVID-19-associated arthritis', which we propose, is a better term to define the entire spectrum of new-onset arthritis believed to be associated with SARS-CoV-2 infection. We performed a systematic literature review using MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews to search for articles published up to 13 December 2021. We included cohort studies, case series and case reports describing patients diagnosed with COVID-19 reactive or viral arthritis by a physician, irrespective of fulfilment of classification criteria. To identify relevant studies, medical subject headings and keywords related to 'COVID-19/SARS-CoV-2 infection' and 'reactive arthritis' were used. Our search retrieved 419 articles, of which 31 were included in the review. A total of 33 cases were reported in these 31 articles, the majority being adults (28/33=85%) with peripheral joint involvement (26/33=79%). Most of the patients responded well to treatment and the disease was self-limiting. These 33 case reports describe a possible causal relationship between exposure to SARS-CoV-2 and the onset of arthritis. However, since these cases were reported during a pandemic, other aetiologies cannot be fully excluded. The exact mechanism through which SARS-CoV-2 might trigger arthritis is not fully understood and robust epidemiological data to support a causal relationship are still lacking.

Management and outcome of native joint septic arthritis: a nationwide survey in French rheumatology departments, 2016-2017.

OBJECTIVES: To describe current management and outcome of native joint septic arthritis (NJSA) in French rheumatology departments. METHODS: For this retrospective, nationwide multicentric study, 127 French rheumatology departments were contacted to report up to 12 cases of NJSA that occurred between 1 January 2016 and 31 December 2017. Characteristics, diagnosis procedures, therapeutic management and outcome were recorded. RESULTS: Overall, 362 patients were included (mean age 64.0±18.6 years, median Charlson comorbidity index 3.5 (0-14)). Knee was the most frequent site (n=160 (38.9%)), and Staphylococcus sp (n=185 (51.4%)), the most frequent pathogen. All patients received antibiotics for a mean duration of 46.8 (±22.0) days, including intravenous route for a mean of 17.2 (±15.4) days. Management was heterogeneous. Surgical procedure was performed in 171 (48.3%), joint immobilisation in 128 (43.8%). During follow-up, 91 (28.3%) patients have had serious complications and 28 (9.2%) of them died. Factors associated with 1-year mortality were age (OR 1.08, 95% CI 1.04 to 1.13; p<0.001), Charlson's index (OR 1.30, 95% CI 1.06 to 1.58; p=0.012), presence of bacteraemia (OR 4.02, 95% CI 1.35 to 11.99; p=0.008), antibiotic use in the previous 3 months (OR 3.32, 95% CI 1.11 to 9.87; p=0.029) and Staphylococcus aureus NJSA compared with Streptococcus sp. NJSA (OR 7.24, 95% CI 1.26 to 41.68, p=0.027). The complete recovery with no adverse joint outcome at 1 year was observed in n=125/278 patients (55.0%). CONCLUSION: Prognosis of NJSA remained severe with a high rate of morbimortality. Its management was very heterogeneous. This study highlights the importance of the new French recommendations, published after the completion of the study, in order to facilitate NJSA management.

Disseminated Pasteurella multocida in a patient with liver cirrhosis and spontaneous bacterial peritonitis - The role of cirrhosis-associated immune dysfunction.

Disseminated Pasteurella multocida infection is rare and usually occurs in patients who are immunocompromised. Patients with liver cirrhosis seem to be particularly vulnerable; potentially related to cirrhosis associated immune dysfunction syndrome, frequently present in this population. While many patients report pet cat or dog bites or scratches, some patients develop infection even without obvious exposure, just from being in contact with animals. We present a patient with cellulitis and spontaneous bacterial peritonitis by Pasteurella multocida in whom infection disseminated and the patient developed bacteremia that seeded in the right acromioclavicular joint. We hypothesize that the port of entry for infection in our patient was contact with a pet cat through a chronic open leg wound. The patient was treated with intravenous ceftriaxone 2 g daily for 6 weeks and attained complete recovery.

Osteomyelitis on MR imaging as a key predictor of recurrent septic arthritis of the shoulder.

OBJECTIVES: To investigate the clinical and radiologic predictors of postoperative recurrent septic arthritis of the shoulder (SAS) using multivariable analysis. METHODS: Forty-three patients (mean age, 65 years; 24 women) who underwent surgery for SAS between January 2011 and October 2019 were retrospectively enrolled. An orthopedic surgeon assessed clinical (age, sex, comorbidity, duration from symptom onset to MR imaging and surgery, surgical method, antibiotic usage), laboratory (serum white blood cell [WBC] count, C-reactive protein [CRP] level, synovial cell count), and surgical findings (culture/biopsy results). Two musculoskeletal radiologists evaluated MR imaging findings (bone marrow [reactive bone marrow edema, osteomyelitis, osteochondral erosion] and soft tissue [synovitis, bursitis, muscle edema, abscess] abnormalities). Recurrent SAS was evaluated at ≥ 12 months postoperatively. Univariable and multivariable analyses were performed to determine the best predictor of recurrent SAS. RESULTS: The overall recurrent SAS rate was 33% (14/43). On univariable analysis, mean age (without recurrence vs. recurrence: 68 vs. 59 years, p = .04), mean duration from symptom onset to surgery (18 vs. 25 days, p = .02), serum WBC count (12,000 vs. 9,000 cells/mL3, p = .04), CRP level (13 vs. 6 mg/L, p = .01), and osteomyelitis on MR imaging (p < .01 for both readers) significantly differed between patients with and without recurrence; on multivariable analysis, only osteomyelitis on MR imaging was significantly associated with recurrent SAS for both readers (p = .02 and .01 for each reader respectively). The inter-reader agreement was good (κ = .62-1.0) for all MR imaging findings, except for muscle edema (fair, κ = .37). CONCLUSION: Osteomyelitis on MR imaging was the best predictor of recurrent SAS. KEY POINTS: • Osteomyelitis on preoperative MR imaging was the best predictor associated with recurrent septic arthritis of the shoulder on multivariable analysis including clinical, laboratory, and MR findings. • In multivariable analyses focused on each bone marrow abnormality, with adjustment for clinical and laboratory parameters, the presence of reactive bone marrow edema and osteochondral erosion on MR imaging showed no significant association with recurrent septic arthritis of the shoulder.

Perfil epidemiológico de los pacientes entre 0 y 15 años con infección osteoarticular en el Hospital Infantil San Vicente Fundación / Epidemiological profile of patients between 0 and 15 years with osteoarticular infection at the San Vicente Fundación Children's Hospital

RESUMEN Introducción: el principal patógeno en las infecciones osteoarticulares es el Staphylococcus aureus, los esquemas de tratamiento recomendados se basan en la literatura estadounidense o europea, no hay datos de estudios locales. El propósito de este estudio es conocer el perfil epidemiológico en las infecciones osteoarticulares del Hospital Infantil San Vicente Fundación (Medellín, Colombia) y las características de los pacientes afectados. Materiales y métodos: revisión retrospectiva de historias de pacientes entre los 0 y 15 años con diagnóstico de infección osteoarticular en el Hospital Infantil San Vicente Fundación, se detallaron las variables demográficas de la patología y los antecedentes relevantes para caracterizar el perfil epidemiológico de las infecciones osteoarticulares. Resultados: identificamos 72 pacientes con infección osteoarticular. La infección más común fue la artritis séptica (40 %), seguida por la osteomielitis aguda (37 %). La cadera (18 %) y la tibia (31 %) fueron la articulación y el hueso afectados con mayor frecuencia. La mayoría de las infecciones fueron secundarias a S. aureus (65 %), de estas fueron por Stafilococo aureus meticilino sensible (SAMS) el 38,9 % y por Stafilococo aureus meticilino resistente (SAMR)el 26,4 %. El tratamiento antibiótico empírico y el tratamiento definitivo se basó en cefalosporinas de primera generación en 83 % y 52,7% de los casos, respectivamente. La principal complicación fue la sepsis en 18 (25 %) pacientes. Conclusiones: se debe tener un alto índice de sospecha, no todos los pacientes se presentan con síntomas o signos típicos. El patógeno principal es el Staphylococcus aureus. En los últimos 10 años ha aumentado la incidencia de las infecciones por SAMR en nuestra institución en relación con estudios previos. Notamos una demora en el diagnóstico y, por ende, en el inicio del tratamiento.

SUMMARY Introduction: The main pathogen in osteoarticular infections is Staphylococcus aureus. The recommended treatment schemes are based on American or European literature, there are no data from local studies. The purpose of this study is to know the epidemiological profile in osteoarticular infections of the San Vicente Fundación children's hospital (Medellín/Colombia) and the characteristics of the affected patients. Materials and methods: Retrospective review of histories of patients between 0 and 15 years old with a diagnosis of osteoarticular infection in the San Vicente Fundación children's hospital detailing demographic variables, pathology and relevant antecedents to characterize the epidemiological profile of osteoarticular infections in the hospital. Results: We identified 72 patients with osteoarticular infection. The most common septic arthritis infection (40%) followed by acute osteomyelitis (37%), the most affected joint was the hip (18%) and the most affected bone was the tibia (31%). The majority of infections were secondary to S. aureus (65%) of which were by SAMS 38.9% and by SAMR 26.4%. Empirical as well as definitive antibiotic treatment was based on first generation cephalosporins 83% and 52.7% respectively. The main complication was sepsis in 18 (25%) patients. Conclusions: There must be a high index of suspicion, not all patients present with typical symptoms and / or signs. The main pathogen Staphylococcus aureushas increased the incidence of MRSA infections in our institution in the last 10 years in relation to previous studies. We note delay in diagnosis and therefore in the start of treatments.

Adult Native Joint Septic Arthritis: A Nine-Year Retrospective Analysis in a Portuguese University Hospital.

INTRODUCTION: Septic arthritis of a native joint represents a medical emergency. Drainage and effective antibiotic treatment are critical to avoid joint destruction and long-term impairment. The aim of this study was to evaluate epidemiological and clinical characteristics of patients with the diagnosis of septic arthritis to help establish local guidelines for empirical antibiotic treatment. MATERIAL AND METHODS: Retrospective analysis of adult patients admitted at Centro Hospitalar Universitário do Porto from 2009 to 2017 with suspected native joint septic arthritis. Relevant demographics, microbiology findings and respective antibiotic susceptibilities were analysed. RESULTS: Ninety-seven patients, predominantly males (59.8%) with a median age of 61 years old were included. The most commonly reported comorbidity associated with septic arthritis was diabetes mellitus (20.6%). The knee was the most commonly affected joint (71.1%). Arthrocentesis was performed in all patients, but only 50.5% had positive microbial growth in the synovial fluid. Staphylococcus aureus was the most frequently identified microorganism, 86% of which were methicillin susceptible. Gram-negative bacteria were the causative agent in 15% of cases. A wide range of empirical antibiotic regimens were prescribed with a combination of vancomycin/carbapenem being the most common (30.9%). Analysis of antibiotic susceptibility profiles revealed that amoxicillin/clavulanate would have been appropriate as the initial regimen in 89% of cases. DISCUSSION: The main causative pathogen was Staphylococcus aureus, with methicillin resistant Staphylococcus aureus remaining rare. The proportion of Gram-negative bacteria implies that these agents should be covered by empirical treatment, although no case of Pseudomonas infection has been identified. Therefore, antipseudomonal coverage is not necessary in empirical regimens. CONCLUSION: Routine coverage of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is not warranted but must be considered when specific risk factors are found. Amoxicillin/clavulanate can provide adequate antibiotic coverage as an empirical treatment for adult native joint septic arthritis. Its use may allow a reduction in use of broader spectrum antibiotics.

Introdução: A artrite séptica representa uma patologia grave que pode levar à destruição articular e diminuição funcional a longo prazo. Adicionalmente à drenagem articular, uma antibioterapia efetiva é crucial. O objetivo deste estudo consistiu em avaliar as características epidemiológicas e clínicas dos doentes admitidos com diagnóstico de artrite séptica e analisar a terapêutica antimicrobiana, estabelecendo orientações locais de tratamento antibiótico empírico. Material e Métodos: Análise retrospetiva de doentes adultos admitidos no Centro Hospitalar Universitário do Porto com artrite séptica de articulação nativa de 2009 a 2017. Foram revistos os resultados microbiológicos, os perfis de suscetibilidade aos antimicrobianos e os registos médicos. Resultados: Dos 97 doentes incluídos, 59,8% eram do género masculino, com uma idade média de 61 anos. A comorbilidade mais comum foi a diabetes mellitus (20,6%). O joelho foi a articulação mais afetada (71,1%). Realizou-se artrocentese em todos os doentes, com isolamento microbiano em 50,5% dos produtos. O Staphylococcus aureus foi o microrganismo mais frequente, sendo sensível à meticilina, em 86% dos casos. As bactérias Gram-negativo foram o agente causal em 15% das infeções. A associação do carbapenemo e vancomicina foi a antibioterapia empírica mais comummente iniciada (30,9%), embora em 89% dos casos a amoxicilina/clavulanato teria sido apropriada como regime inicial. Discussão: O principal agente etiológico foi o Staphylococcus aureus, continuando o Staphylococcus aureus resistente à meticilina a ser um agente raro. A percentagem de bactérias Gram-negativo implica a sua cobertura como terapêutica empírica, embora não tenha havido casos de infeção por Pseudomonas. Por isso, a utilização empírica de um antibiótico com atividade antipseudomónica não é necessária. Conclusão: A cobertura antibiótica de Staphylococcus aureus resistente à meticilina e Pseudomonas não é obrigatória, mas pode ser considerada na presença de alguns fatores de risco específicos. A amoxicilina/ clavulanato é uma antibioterapia empírica adequada para a artrite séptica de articulação nativa, permitindo reduzir a utilização inadequada de antibióticos de espectro mais alargado.

Recurrent Nontuberculous Mycobacterial Tenosynovitis.

Background: Nontuberculous mycobacteria are an uncommon pathogen for musculoskeletal infection and are difficult to treat because of delays in diagnosis, prolonged treatment requiring both antimycobacterial therapy and surgical debridement, and high rates of resistance to antimycobacterial therapy. Case Report: We report the case of an 88-year-old male with recurrent Mycobacterium avium complex tenosynovitis despite receiving multiple courses of pharmacologic therapy and surgical debridement. Conclusion: Nontuberculous mycobacterial musculoskeletal infections can be difficult to diagnose and equally difficult to treat. A combination of antimycobacterial therapy and surgical debridement is often required; however, the rate of treatment failure remains high, particularly with rapidly growing mycobacteria such as Mycobacterium avium.

DOUBLE FEMORAL OSTEOTOMY FOR THE TREATMENT OF SEVERE SEQUELAE OF THE IMMATURE HIP.

OBJECTIVE: To evaluate the results of double femoral osteotomy for the treatment of severe sequelae of the hip. METHODS: Immature patients with anatomical loss of the hip were treated with pelvic support osteotomy in the distal femur to correct lower limb shortening, they were evaluated clinically and radiographically. RESULTS: Eleven cases (eleven hips) were assessed with verage follow-up of three years. The mean age of the patients was 14.7 years. Seven patients had sequela of infectious arthritis; three had sequela of developmental dysplasia of the hip and one patient had a sequela of slipped capital femoral epiphysis. Preoperatively, the gluteus medius was insufficient in all patients, and it became negative in ten of them. The average of lower limb shortening was 5 cm (2.5 to 7 cm) and reduced shortening was 1.9 cm (0 to 4 cm). According to Paley Classification, 72.7% of complications were considered problems, 90.9% were considered obstacles and 27.2% complications, among which the limitation of the knee flexion was the most frequent. CONCLUSION: The technique yielded good results, considering the severity of the sequela and the absence of a better therapeutic option. No important sequela was associated with the treatment. Level of Evidence IV, Case series.

OBJETIVO: Avaliar os resultados do tratamento de graves sequelas do quadril pela dupla osteotomia do fêmur. MÉTODOS: Pacientes imaturos, com perda da articulação do quadril, foram tratados com osteotomia de apoio pélvico associada à osteotomia na região distal do fêmur para correção do eixo do membro inferior e do encurtamento, foram avaliados clínica e radiograficamente. RESULTADOS: Onze casos (onze quadris) foram avaliados, com seguimento médio de três anos. A média de idade no tratamento foi de 14,7 anos. Sete indivíduos tinham sequela de artrite séptica, três de displasia do desenvolvimento do quadril e um de escorregamento epifisário proximal do fêmur. Pré-operatoriamente, a marcha por insuficiência do glúteo médio esteve presente em todos os sujeitos e se tornou negativa em dez deles. O encurtamento médio inicial do membro afetado foi de 5 cm (2,5 a 7 cm) e o reduzido teve média de 1,9 cm (0 a 4 cm). Segundo classificação de Paley, 72,7% apresentaram intercorrências consideradas problemas, 90,9% obstáculos e 27,2% complicações, entre as quais a limitação da amplitude de movimento do joelho foi a mais frequente. CONCLUSÃO: A técnica produziu bons resultados em face da gravidade da sequela e da falta de outra opção terapêutica melhor. Não houve sequela importante associada ao tratamento. Nível de Evidência IV, Série de casos.

Clinical Characteristics and Causative Pathogens of Infective Arthritis and Risk Factors for Gram-Negative Bacterial Infections.

BACKGROUND: The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis. MATERIALS AND METHODS: Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively. RESULTS: A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%). The most frequently identified microorganisms were Staphylococcus aureus (51.1%), followed by Streptococci sp. (21.1%), Enterobacteriaceae (8.4%), and coagulase-negative-Staphylococci (CNS; 8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant S. aureus (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections. CONCLUSION: Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered.

Double femoral osteotomy for the treatment of severe sequelae of the immature hip / Dupla osteotomia do fêmur para o tratamento de graves sequelas no quadril imaturo

ABSTRACT Objective: To evaluate the results of double femoral osteotomy for the treatment of severe sequelae of the hip. Methods: Immature patients with anatomical loss of the hip were treated with pelvic support osteotomy in the distal femur to correct lower limb shortening, they were evaluated clinically and radiographically. Results: Eleven cases (eleven hips) were assessed with verage follow-up of three years. The mean age of the patients was 14.7 years. Seven patients had sequela of infectious arthritis; three had sequela of developmental dysplasia of the hip and one patient had a sequela of slipped capital femoral epiphysis. Preoperatively, the gluteus medius was insufficient in all patients, and it became negative in ten of them. The average of lower limb shortening was 5 cm (2.5 to 7 cm) and reduced shortening was 1.9 cm (0 to 4 cm). According to Paley Classification, 72.7% of complications were considered problems, 90.9% were considered obstacles and 27.2% complications, among which the limitation of the knee flexion was the most frequent. Conclusion: The technique yielded good results, considering the severity of the sequela and the absence of a better therapeutic option. No important sequela was associated with the treatment. Level of Evidence IV, Case series.

RESUMO Objetivo: Avaliar os resultados do tratamento de graves sequelas do quadril pela dupla osteotomia do fêmur. Métodos: Pacientes imaturos, com perda da articulação do quadril, foram tratados com osteotomia de apoio pélvico associada à osteotomia na região distal do fêmur para correção do eixo do membro inferior e do encurtamento, foram avaliados clínica e radiograficamente. Resultados: Onze casos (onze quadris) foram avaliados, com seguimento médio de três anos. A média de idade no tratamento foi de 14,7 anos. Sete indivíduos tinham sequela de artrite séptica, três de displasia do desenvolvimento do quadril e um de escorregamento epifisário proximal do fêmur. Pré-operatoriamente, a marcha por insuficiência do glúteo médio esteve presente em todos os sujeitos e se tornou negativa em dez deles. O encurtamento médio inicial do membro afetado foi de 5 cm (2,5 a 7 cm) e o reduzido teve média de 1,9 cm (0 a 4 cm). Segundo classificação de Paley, 72,7% apresentaram intercorrências consideradas problemas, 90,9% obstáculos e 27,2% complicações, entre as quais a limitação da amplitude de movimento do joelho foi a mais frequente. Conclusão: A técnica produziu bons resultados em face da gravidade da sequela e da falta de outra opção terapêutica melhor. Não houve sequela importante associada ao tratamento. Nível de Evidência IV, Série de casos.