Unusual Complication in a septic hip Jong Sup Shim Samsung Medical Center Sungkyunkwan University School of Medicine.

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Presentation transcript:

Unusual Complication in a septic hip Jong Sup Shim Samsung Medical Center Sungkyunkwan University School of Medicine

6 yr-old boy ( Chief Complaint) - Severe left hip pain - Left hip deformity and bed-ridden state Onset) 2 months

Initial X-ray

Past medical history 4 months ago, -I&D of the left hip joint (anterior approach) under diagnosis of pyogenic arthritis. -Hip spica cast for 2 months -Passive Hip Motion restriction for additional 2 months -(IV Antibiotics for 6 weeks postoperatively)

Initial Postop. 2 mo X-ray From other hospital

Postop. 3 mo X-ray From other hospital

Physical Examination Left Hip Joint -Sever pain on passive motion -Abducted & external rotated -Local heat(-) -Swelling(-) -Tenderness(-) Left Knee Joint - Quadriceps m weakness (< grade III)

Lab. & Bone Scan ESR, CRP : normal range Triphasic Bone scan: infection(-)

MRI(T2WI)

What is the best management for this boy?

Passive exercise 3 weeks Treatment

Passive exercise 6 weeks Treatment

Operation Anterior approach - extracapsular antero-lateral release : Iliopsoas, Sartorius, TFL, G minimus - Intracapsular release (anterolateral half of the head- cartilage defect) : adhesiolysis, capsulotomy Intraoperative post-release ROM F/D:0, F/F: 100, Add: 10, Abd: 60 I/R: 20, E/R: 60 Treatment

Postop. X-ray

Postop management Lateral traction by pelvic sling Distal skin traction Postop 1wk - Active and passive exercise (3 times a day) Postop 6 wks -SLR, active abduction & adduction -one-crutch walking Postop 4 wks - night-time traction start standing

Immediate postop.

Postop 1 mo

Postop. 2 mo

Postop. 6 mo (Hip Motion- F/D:0, F/F:120, Add:20, Abd:50 I/R:20, E/R:20)

Postop. 9mo

Postop 1 yr

Postop. 2 yr

Postop. 3 yr

Postop 1 moPostop 3 yrInitial

Present status 9yr old Hip ROM : F/D:0/0, F/F: 130/130, Abd.: 60/60, I/R: 50/30, E/R: 60/70 Knee: normal motion and function Limping (-): Normal School Activity Leg-length: 1cm shortening, left

Expected Future Problems Leg-Length Discrepancy Neck-Shaft Deformity (Coxa breva, Coxa vara ?) Early Degenerative Arthritis

Conclusion Common knowledge and understanding of the septic hip is very important for initial treatment. Also, initial treatment is very important to minimize perioperative complication and long- term sequelae.

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