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REVIEW ON SEPTIC ARTHRITIS OF HIP IN CHILDHOOD.

Royal Hospital for Sick Children, Yorkhill, Glasgow

Aim: To study the epidemiology, diagnostic criteria and outcome of Septic Arthritis (SA) of hip in infancy and childhood

Method: Retrospective case notes review of 43 cases of Primary SA of hip. Diagnostic criteria used: 1. Confirmed SA: positive joint fluid culture/positive blood culture and elevated WCC in joint fluid / radiological changes. 2. Presumed SA: Negative cultures but elevated WCC in joint fluid. The outcome was rated as A. Satisfactory: clinically and radiology normal hip. B. Unpredictable: clinically normal hip with radiological changes. C. Unsatisfactory: clinically abnormal hip.

Results: We had 37 cases of confirmed SA and 6 cases of presumed SA. Mean age of presentation was 4 years with male to female ratio of 3:2. All cases had either joint aspiration or arthrotomy. The 25% of cases with negative joint fluid cultures had a history of recent antibiotic use. Radiological changes were found in 40% cases. Mean duration of follow up was 33 months. Outcome was rated as satisfactory in 61%, unsatisfactory in 7% and unpredictable in 31%. Of confirmed SA cases 57% had a satisfactory outcome. The delay in the initial presentation was more than a week in all cases with unsatisfactory results.

Conclusions: Our study outlines the demographic and microbiological profile of SA of the hip in children. Diagnosis in culture negative cases can be challenging, especially with a history of recent antibiotic use. Prolonged initial delay in presentation was associated with unsatisfactory outcomes.

Correspondence should be addressed to: Mr J. B. Hunter, BSCOS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.