[Acute, haematogenous arthritis of the hip in children--treatment and long follow-up assessment].

Abstract

Background: This is a retrospective study of 15 cases of acute septic arthritis of the hip in older children treated from 1995 to 2007.

Materials and methods: All treated children were over 2 years old. The average follow-up period was 7 years (2-16 years). Among patients, there were 11 males and 4 females. None of them had bilateral disease presentation. All cases met the diagnostic criteria including bacteriological results, clinical or radiographic changes. The average duration of symptoms before admission to the hospital was 6,5 days (1-35 days). Pain in affected hip was observed in all patients, other symptoms were: limited range of motion (12 patients), fever (14 patients), abdominal or thigh pain (4 patients). Only one-third of the patients had a leukocyte count of over 12 000/mm3, the erythrocyte sedimentation rate was elevated in all cases--average 80/125, CRP ranged from 3.1-205 mg/l. 13 cases underwent emergency arthrotomy and debridement, two patients received only intravenous antibiotic treatment without arthrotomy. Pathogens had been isolated from blood only in 3 cases (20%), from arthrocentesis fluid in 8 patients (62%). Staphylococcus aureus was the most common pathogen (54%).

Results: All patients had been succesfully treated. 10 of them had good result, 3 satisfactory and 2 unsatisfactory according to Kiepurska criteria.

Conclusions: A delay in definite treatment was the important factor associated with poor prognosis. One patient who received only intravenous antibiotic treatment showed satisfactory result - early diagnosis and significant response to antibiotics contributed to this favorable outcome.