Reconstruction of the hip joint in children after septic coxitis

Background.Surgical treatment of destructive dislocations is problematic, and controversial. Treatment options range from active monitoring to complex multistage reconstruction protocols.Materials and methods.The results of treatment of 17 children with disruptive dislocation of the hip (class IV according to the Choi classification) are presented. The mean age at which treatment was started was 6.3 ± 0.5 years (range: 3-9 years). Treatment strategies included formation of the weight-bearing contact of the proximal femur and acetabulum and ilium osteotomy using an Ilizarov frame. The follow-up period lasted from 2 to 11 years. Clinical results were assessed using Colton’s criteria. Assessment of the radiology findings included the anatomy relations and congruence of the articular surfaces. The patients were divided into two groups, according to age, for data analysis.Results.The majority (88%) of the children had positive anatomical and functional outcomes. The functional results were good (12-15 points), satisfactory (9-11 points), and unsatisfactory (8 points) for 3, 5, and 1, respectively, among 3-6 year olds and 2, 6, and 0, respectively, among 7-9 year olds. The distribution of joint congruence types I, III, and IV was 2, 4, and 3, respectively, in the younger group and 1, 6, and 1, respectively, in the older group.Conclusion.The use of reconstructive surgery using the Ilizarov apparatus in children with a defect of the proximal femur creates conditions for the adaptation of incongruent articular components without causing decompensation of the joint.

Two-staged surgical treatment of hip septic arthritis

Hip arthritis (coxitis) is the inflammatory process in the hip, requiring complicated and lengthy treatment. At some cases it is associated with serious complications, up to patient’s disability due to the femoral head destruction. The treatment goal is to halt inflammation for further hip arthroplasty and functional rehabilitation. Arthroplasty is performed using the commercially available cement antibiotic-impregnated articulating spacers. The article reviews a number of clinical examples of two-staged surgical treatment of hip septic arthritis using articulating spacers with further hip arthroplasty. Experts, including native specialists, in the periodicals and clinical practice question the effectiveness of two-staged treatment. The experience of effective use of commercially available bone cement antibiotic-impregnated articulating spacers is presented. The method allows to halt the inflammation, to avoid the significant femoral shortening and acetabulum filling by scar tissue, to preserve hip function and provides the patient an opportunity to move with a partial load on the operated limb while waiting for the arthroplasty, as well as improves the conditions for hip implant consolidation. After suppressing the inflammation, the described method, providing a moderate load on the affected bone, enhances the bone mineral density increase both of femur and acetabulum. Two-staged treatment of septic coxitis decreases the risk for infective complications after the total hip replacement.