Greater trochanteric preserving hip arthroplasty in the treatment of infantile septic arthritis: long-term results
Balanced forces around the hip joint are critical for normal development of the hip joint, so it should be considered in every hip reconstructive procedure.
In seven children with complete destruction of the femoral head and neck due to septic arthritis, a reconstructive hip surgery was done to reconstruct the femoral head without sacrificing the greater trochanter and its muscles completely. The technique consists of a modified greater trochanter arthroplasty with only a medial portion of the greater trochanter and a varus femoral osteotomy.
The average age of the children at surgery was 17 months (range 8–36 months) and the patients were followed for an average of 16.6 years (range 10.9–20.1 years). The average number of second operative procedures for each patient was 2 (range 1–4). The follow-up evaluation for each patient included documentation of pain, hip range of motion, and assessment of gait. In addition, the current leg-length discrepancy, final coverage and stability of the hip joint were documented. At final evaluation, all patients had a pain-free stable hip and two patients had near-normal hip range of motion. All patients have had satisfactory surgery results.
By this kind of hip reconstruction, we could provide a stable painless hip joint with special attention to the greater trochanter’s role on hip biomechanics.
KeywordsHip Septic arthritis Deformities Infancy
- 1.Gillespie R (1973) Septic arthritis of childhood. Clin Orthop Relat Res 96:152–159Google Scholar
- 2.Obletz BE (1960) Acute suppurative arthritis of the hip in the neonatal period. J Bone Joint Surg Am 42:23–30Google Scholar
- 3.Paterson DC (1970) Acute suppurative arthritis in infancy and childhood. J Bone Joint Surg Br 52:474–482Google Scholar
- 4.Hunka L, Said SE, MacKenzie DA et al (1982) Classification and surgical management of the severe sequelae of septic hips in children. Clin Orthop Relat Res 171:30–36Google Scholar
- 7.Choi IH, Pizzutillo PD, Bowen JR et al (1990) Sequelae and reconstruction after septic arthritis of the hip in infants. J Bone Joint Surg Am 72:1150–1165Google Scholar
- 8.Dal Monte A, Capelli A, Donzelli O et al (1984) Trochanteroplasty in the treatment of infantile septic arthritis of the hip. Ital J Orthop Traumatol 10:145–152Google Scholar
- 10.Mitchell GP (1980) Management of acquired dislocation of the hip in septic arthritis. Orthop Clin North Am 11:51–64Google Scholar
- 12.Colonna PC (1935) A new type of reconstruction operation for old ununited fracture of the neck of the femur. J Bone Joint Surg 17:110–122Google Scholar
- 13.Freeland AE, Sullivan DJ, Westin GW (1980) Greater trochanteric hip arthroplasty in children with loss of the femoral head. J Bone Joint Surg Am 62:1351–1361Google Scholar
- 14.Dobbs MB, Sheridan JJ, Gordon JE et al (2003) Septic arthritis of the hip in infancy: long-term follow-up. J Pediatr Orthop 23:162–168Google Scholar
- 15.Hallel T, Salvati EA (1978) Septic arthritis of the hip in infancy: end result study. Clin Orthop Relat Res 132:115–128Google Scholar
- 16.Weissman SL (1967) Transplantation of the trochanteric epiphysis into the acetabulum after septic arthritis of the hip. Report of a case. J Bone Joint Surg Am 49:1647–1651Google Scholar