Native hip joint septic arthritis in 20 adults: delayed presentation beyond three weeks predicts need for excision arthroplasty.
OBJECTIVE
Septic arthritis of native hip joints is an uncommon condition in adults in Western Europe, but continues to present a challenge to medical and surgical management. We set out to study the natural history and bacteriology of the disease in this group, with a particular focus on patients requiring excision arthroplasty (EA).


METHODS
We retrospectively studied 26 secondary referral cases (20 adults) managed by a specialist bone infection unit over a 12 year period.


RESULTS
Our patient cohort was diverse, affecting all age groups in the presence and absence of co-morbid conditions. The commonest pathogen was Staphylococcus aureus. Of 20 adults studied, five (25%) required EA. Symptom duration prior to presentation was a statistical predictor of the requirement for EA (p<0.003); in particular, symptom duration of over three weeks was strongly associated with requirement for this procedure (p<0.0003).


CONCLUSIONS
In cases that present promptly, combined surgical drainage and intravenous antibiotics should be expected to eradicate infection and to salvage the femoral head. Cases presenting following a delay are more likely to require EA and subsequent hip reconstruction.
Matthews
Philippa C
PC
Bone Infection Unit, Nuffield Orthopaedic Centre NHS Trust, Windmill Road, Headington, Oxford OX3 7LD, UK. p.matthews@doctors.org.uk
Dean
Benjamin J F
BJ
Medagoda
Kushan
K
Gundle
Roger
R
Atkins
Bridget L
BL
Berendt
Anthony R
AR
Byren
Ivor
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019643:Arthroplasty, Replacement; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013997:Time Factors