All issues > Volume 34(2); 1991

Original Article

J Korean Pediatr Soc. 1991;34(2):197-205. Published online February 28, 1991.

Acute pyogenic arthritis of hip in neonate and infant.

Mi Jung Kim¹, Young Ah Lee¹, Young Pyo Chang¹, Hoan Jong Lee¹, Jung Hwan Choi¹, Chong Ku Yun¹, Hak Jin Min², In Ho Choi²

¹Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
²Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Korea

Received: September 19, 1990;  Accepted: November 9, 1990.

Abstract

Acute pyogenic arthritis of hip is a serious infection that can lead to truly devastating complica- tions especially in neonatal period and infancy. Clinical survey on twelve neonates and infants (14 hip joints) with acute pyogenic arthritis of hip who were admitted to the Departments of Pediatrics and Orthopedic Surgery, Seoul National University Hospital from Jan. 1980 to Dec. 1989 were done. The results were summarized as follows: 1) Male to female ratio was 1.4:1 and 58% of total cases was under 4 weeks of age with higher incidence in neonatal period. 2) The predisposing factors were found in the 83% of cases. Most of them were associated with iatrogenic factors, which were composed of femoral venipuncture in 7 cases, vaccination in 2 cases, IM injection in 1 case and IV site cellulitis in 1 case. The mean time from femoral venipuncture to local symptom was 2.5 days. 3) The main clinical symptom and sign were pain on motion and limitation of motion. The classical systemic symptom such as high fever was infrequent. 4) Causative microorganisms were isolated in 7 cases (58%) and Staphylococcus aureus was the most common microorganism(71%). 5) The sequelae were found in 8 cases(57%): instability of hip in 6 cases, limited range of motion in 4 cases and severe deformity on femoral head in 3 cases. 6) Incidence of sequelae according to prognostic factors was as follows: arthritis complicated by osteomyelitis; 83%, time elapsed from local symptom to arthrotomy more than 6 days; 80%, arthritis developed in neonatal period; 67%, S. aureus as causative microorganism; 67%. In conclusion, it is important to perform aseptic procedure especially in neonatal period and early diagnosis and urgent surgical treatment is required to minimize irreversible damage in acute pyogenic arthritis of hip.

Keywords :Acute pyogenic arthritis of hip;Neonate;Infancy