Abstract
Septic arthritis of the hip remains a serious problem in our environment. The diagnosis is difficult and treatment is challenging. Particularly in patients presenting late, the outcome may be poor.
From January 1998 to December 2002, 27 children were admitted to the paediatric unit with the diagnosis of septic arthritis. Their ages ranged from 2 to 12 years and the duration of symptoms ranged from 3 days to 3 months. Pain, fever and a limp were the main clinical features. Only one child had bilateral involvement. Laboratory investigations revealed Staphylococcus in 20 children, Serratia in one, Pseudomonas in one and Haemophilus influenza in one. In four patients no growth was identified. Initial radiological findings ranged from no abnormalities in 18 children, to capsular distention in six and hip dislocation in three. Ultrasonography, CT scan and bone scan were also performed. All patients underwent surgical exploration. Twelve had septic arthritis, six pelvic osteomyelitis and five proximal femoral osteitis. There were two psoas abscesses, a buttock abscess and a case of inguinal lymphadenitis. Follow-up ranged from 3 months to 5 years.
Only eight children had a good outcome and full range of movement. There were six cases of ankylosis, 10 of avascular necrosis and three of dislocation.
Thorough clinical and radiographic examination is advocated in patients with apparent septic arthritis, as misdiagnosis is common. The infection may be in the pelvis, femoral neck or related soft tissues.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
