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

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

3. Initial X-ray

4. 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)

5. Initial Postop. 2 mo X-ray From other hospital

6. Postop. 3 mo X-ray From other hospital

7. 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)

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

9. MRI(T2WI)

10. What is the best management for this boy?

11. Passive exercise 3 weeks Treatment

12. Passive exercise 6 weeks Treatment

13. 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

14. Postop. X-ray

15. 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

16. Immediate postop.

17. Postop 1 mo

18. Postop. 2 mo

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

20. Postop. 9mo

21. Postop 1 yr

22. Postop. 2 yr

23. Postop. 3 yr

25. Postop 1 moPostop 3 yrInitial

26. 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

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

28. 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.

29. 감사합니다