[Hip septic arthritis in young children with sickle-cell disease].
OBJECTIVE
Sickle-cell anemia is an inherited disorder exposing patients to diverse complications, particularly bone and joint disease. Septic arthritis of the hip joint is a frequent infection in sickle-cell anemia. Without early management, there is an important risk of invalidating hip dysfunction. The purpose of this study was to analyze the epidemiological, clinical and therapeutic aspects of septic arthritis of the hip joint in order to focus on the need for early diagnosis, the best way to improve the prognosis of hip function.


METHODS
This was a retrospective study over a 10 year period (1987-1996) which included nine children (seven boys and two girls), mean age six years who were managed in our hospital for septic arthritis of the hip joint. These children had at least one hemoglobin S: phenotypes SS (n=5), SC (n=2), AS (n=2).


RESULTS
In these sickle-cell anemia children, the septic arthritis developed in a non traumatic context with osteonecrosis of the femoral head. One hip was involved in six children and both in three (12 hips). Mean time from symptom onset to consultation was eight days. Salmonella sp. were identified in nine hips (including all of the bilateral cases) and Staphylococcus sp. in three. The treatment included antibiotics for six weeks, puncture-drainage, and immobilization for three to four weeks. Outcome was excellent in nine hips and good in three.


CONCLUSIONS
The diagnosis of septic arthritis of the hip joint must be made early, based on ultrasound or scintigraphic findings. Bacteriological samples of joint fluids are required to adjust the antibiotic regimen. Salmonella sp. were the most common agents in our patients, but other series have reported Klebsiella pneumoniae and Staphylococcus or Pneumococcus sp. Drainage is preferred, if possible by arthroscopy. Arthrotomy should be reserved for cases with a thick discharge which is difficult to evacuate via puncture drainage. Early diagnosis, careful evacuation of the joint collection, and adapted antibiotic therapy with hip immobilization are the keys to good functional outcome.
Akakpo-Numado
G K
GK
Service de chirurgie pédiatrique, CHU Tokoin de Lomé, B.P. 57, Lomé, Togo. akanugregoire@yahoo.fr
Gnassingbe
K
K
Songne
B
B
Amadou
A
A
Tekou
H
H
D000755:Anemia, Sickle Cell / Q000150:complications*; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006621:Hip Joint; D006801:Humans; D008297:Male; D012189:Retrospective Studies