Suppurative arthritis of hip in a walking child: Effect of patient’s age, delay in surgical drainage, and organism virulence

Abstract

Introduction: We undertook a retrospective study to stratify the effect of patient’s age, delay in surgical drainage, and Staphylococcus aureus (SA) virulence on expected clinicoradiological outcomes following suppurative arthritis of hip joint in a walking child. Materials and methods: The study was conducted in 18 children over 2 years of age who suffered from joint fluid culture-positive SA arthritis of hip joint and treated with open arthrotomy. Outcomes were defined on the following criteria: age of child (≥5 years or <5 years), duration of symptoms elapsed before surgical intervention (≥5 days or <5 days), and virulence of SA (methicillin-resistant Staphylococcus aureus (MRSA)/methicillin-sensitive Staphylococcus aureus )). The final clinical results were graded according to Moon’s clinical criteria and radiologically by types described by Choi et al. Results: The mean patient age was 6.22 years at the time of index procedure. The average delay in surgery was 17.06 days. Follow-up averaged 15.28 months. Five patients had associated with osteomyelitis femur in preoperative radiographs. MRSA culture was grown in 8 hips (44.4%) of 18 hips. Unsatisfactory clinical results according to Moon’s criteria were obtained in 55.6% patients with 38.9% being MRSA infected. Unsatisfactory Choi’s radiological results were present in 33.3% patients, 27.8% under MRSA category. Our study did not find age to be a significant factor either in clinical or radiological outcome. The clinical results were unsatisfactory in 81.8% patients with surgical delays when compared to early surgery ( p < 0.05). Conclusions: The clinicoradiological outcome in suppurative hip arthritis of walking children was unsatisfactory when there was delay in treatment beyond 5 days, and the causative organism was virulent (MRSA). The presence of preoperative joint incongruency or osteomyelitis of proximal femur was another risk factor.