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

Abstract

We undertook a retrospective study to stratify the effect of patient's age, delay in surgical drainage, and <i>Staphylococcus aureus</i> (SA) virulence on expected clinicoradiological outcomes following suppurative arthritis of hip joint in a walking child. 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 <i>Staphylococcus aureus</i> (MRSA)/methicillin-sensitive <i>Staphylococcus aureus</i>)). The final clinical results were graded according to Moon's clinical criteria and radiologically by types described by Choi et al. 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 (<i>p</i> < 0.05). 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.