Background: Pathological dislocation of hip following episode of septic arthritis is a long recognized complication. We determined clinicoradiological outcome in 14 children presenting with acute septic dislocation of hip and reduced at the time of emergency arthrotomy and drainage. Methods: The retrospective study was conducted at a tertiary care health centre located at suburb of a low income country. The study involved a 10 years chart review of children with confirmed septic arthritis of hip presenting with complication of acute joint dislocation and treated with open reduction at the time of arthrotomy and surgical drainage. All included patients were provided postoperative abduction splintage for minimum 3 months. The clinical evaluation at final follow up was done using modified Moon's criteria for outcome assessment. The radiological outcome was analyzed in terms of containment (Severin class), sequelae (Choi radiological types) and effect on acetabular development (acetabular index, AI). The AI on normal and reduced sides was compared statistically. Results: Average patient age at the time of presentation was 7.2 months and follow up available was 32 months (range, 12e70 months). Functionally, 5 had excellent and 6 had good outcomes at the final follow up. Two patients had fair whereas 1 had poor outcome. Seven hips were Severin class II, 4 class III and 2 class IV and 1 was class VI. One patient had Choi type IA, 3 type IB, 8 type IIA, 1 type IIB and only 1 had type IVA at follow up. The mean AI of reduced hip was 23.4 and was significantly higher than that of unaffected side (mean 15.7 ). Conclusions: The complication of acute septic dislocation of hip in children may not have a sinister prognosis as commonly believed. These hips however were associated with significant acetabular dysplasia in the follow up period.
The analysis determined the relapses in clubfoot children treated with Ponseti technique and standard bracing protocol and their correlation with overall follow up duration using pooled data from various series. It also tested the prescribed timelines of 5 and 7 years for slow-down/cessation of relapses in clubfoot children. Methods: A systematic literature search was performed for articles published in "Pubmed (includes Medline indexed journals)" electronic databases using key words: "Clubfoot or CTEV or congenital talipes equinovarus", "Ponseti" for years 1 st January 2001 to 15 th November 2020. Included were studies that addressed treatment of idiopathic clubfoot using the standard Ponseti technique, followed a well defined brace protocol (maintenance of corrected deformity using a central bar based brace and prescribed duration mentioned), reported a minimum mean follow up of 4 years and having relapse as one of their outcome measure. Studies reporting Ponseti technique for non-idiopathic clubfoot, child's age older than 1 year at the time of primary treatment, clubfoot with previous interventions before Ponseti treatment, where relapse and residual deformities were not identified distinctly in follow up, abstract only publications, letter to the editors, case reports, technique papers and review articles were excluded. The following characteristics of clubfoot patients in the selected articles were included for analysis: Patient numbers/feet treated with Ponseti technique; follow up years (<5; 5-7 and >7 years; overall) and corresponding relapse percentages for patients. Results: There were total 2206 patients in the included 24 studies. Average follow up was 6 years. The average relapse rates for clubfoot patients in the pooled data stood at 30%. The overall relapse rates increased with a longer follow up and the curve befitted a linear regression equation with weak positive correlation (Pearson correlation coefficient ¼ 0.08). The relapse rates in follow up categories of <5 years (26.6 ± 15.6%), 5-7 years (30.8 ± 16.3%) and >7 years (28.4 ± 6.2%) were similar statistically (Analysis of variance, ANOVA). Conclusions: Approximately 1 in 3 clubfoot patients suffer relapse post Ponseti technique and standard bracing protocol. A weak positive correlation was observed for relapses when correlated with increasing follow up years. The relapses however tend to slow down after initial growth years. There is a need to educate the care receivers regarding the possibility of late relapses despite proper Ponseti treatment and accordingly to keep them under supervised follow up for longer periods.
Purpose: Choi IV sequela is one of the most severe outcomes of septic hips. We undertook a retrospective chart review of 15 such hips in 13 patients to identify factors contributing to the formation of this sequelae. Methods: The study specifically focused on patient demographics (patient's age; time to arthrotomy from initial symptoms; causative organism; post arthrotomy duration when Choi IV changes were obvious) and radiological findings at the time of arthrotomy. Results: The average patient's age at time of infection was 2.9 years. Five children were infants. The time to arthrotomy from initial symptoms was mean 21.6 days. Multifocal involvement was seen in 2 patients. Concurrent arthritis and osteomyelitis was present in 8 (53%) and pathological subluxation or dislocation in 9 hips (60%). Methicillin-sensitive Staphylococcus aureus was isolated in 7 and Methicillin-resistant Staphylococcus aureus in 4 patients. The Choi IV findings were established on average 3.8 months post arthrotomy. Conclusions: Delay in treatment, post septic dislocation and concurrent femoral osteomyelitis were factors associated with Choi IV septic sequelae. The pathology occurred irrespective of age.
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