Total hip arthroplasty for treating childhood infection sequelae

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Childhood hip infection may lead to a broad spectrum of residual deformities in the hip. Although total hip arthroplasty (THA) is the treatment of choice to eliminate pain and improve functions for end-stage osteoarthritis, THA in adult patients with childhood hip infection sequelae can be technically challenging because of the extensive and complex deformities. In addition, many surgeons hesitate to offer THA to patients with a history of childhood septic arthritis (SA) for fear of reactivating or recurrent infections. In this article, Youn-Soo Park from the Department of Orthopedic Surgery, Samsung Medical Center, Seoul, South Korea, updates us on the status of THA in patients with childhood infection sequelae in the hip joint—the surgical challenges, prognostic factors, and outcome.

Childhood septic arthritis

Septic arthritis can occur in patients of all ages, but because of the anatomical and physiological characteristics of joints in children, it is mostly found in young children [1]. It is a rare but serious, potentially devastating disease. In a prospective study, it was estimated at an incidence of 1:20,000 among the pediatric population in a region in South Africa [2], and others have estimated it at 1–5 cases per 100,000 in children in developed countries [1]. Correct diagnosis and timely treatment are important for good outcomes but can still result in residual deformities. Childhood hip infection sequelae are more common in poorer, less developed countries [1–3].

The onset of symptoms of SA can be joint swelling and/or sudden joint pain, malaise, a mild limp, inability to bear weight, or the recognition that a leg was not actively moving in an infant; there may or may not be fever at presentation [1, 2, 4, 5]. Staphylococcus aureus (S aureus) is the most frequently encountered pathogen, other organisms such as Streptococcus pneumoniae and Kingella kingae are also frequently found. The frequency of the pathogen can differ depending on the child's age and geographic location [1, 2, 4–6].

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What to do with the long turnaround time of a microbiological culture test?
Adult patients with hip infection sequelae
Is there a good classification system for infection sequelae of the hip?
Challenges of total hip arthroplasty in treating infection sequelae
THA in infection sequelae: Which approach is better?
What is a suitable quiescent period to avoid reactivation of a previous infection?
Childhood infection sequelae vs developmental dysplasia of the hip: a matched-pair study
Prognostic factors influencing outcomes of total hip arthroplasty in infection sequelae
Conclusion

Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

This issue was written by Maio Chen, AO Innovation Translation Center, Clinical Science, Switzerland.

References

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