title: Risk assessment and usefulness of musculocutaneous flap transposition for recurrent septic arthritis of the hip in adults.
abstract: OBJECTIVE
  Septic arthritis of the hip joint in adults often progresses to recurrent infections that require repeated surgeries for treatment. The purpose of the present study was to assess the risk of a recalcitrant hip infection and the usefulness of musculocutaneous flap transposition.
  
  
  METHODS
  15 adult patients who underwent surgeries for the treatment of hip infections were retrospectively analysed. Patients who recovered from infection by undergoing arthroscopy, open irrigation, debridement, continuous irrigation, resection arthroplasty, and/or the placement of antibiotic-loaded acrylic cement were classified into Group A (n = 10). Patients who showed residual infection after multiple surgeries and ultimately recovered after undergoing musculocutaneous flap transposition were classified into Group B (n = 5). The age at onset, sex, incidence of multi-drug-resistant organisms, incidence of infection at other sites, compromising factors, peak preoperative C-reactive protein level, and period from onset to initial surgery were compared between groups.
  
  
  RESULTS
  There was a statistically significant difference in the period from onset to initial surgery (p = 0.024). The infections remained chronic after multiple surgeries in most patients who had complications and/or a poor general or local condition. All of the patients recovered after musculocutaneous flap transposition without the need for additional surgery and did not experience recurrence during the follow-up period in Group B.
  
  
  CONCLUSIONS
  Delayed diagnosis and/or treatment and compromised host caused recurrent septic arthritis of the hip in adults. Musculocutaneous flap transposition may be a useful method for the treatment of recalcitrant hip infection.
authors.affiliation:  Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo - Japan.
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Ohtsuru
authors.affiliation:  Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo - Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Murata
authors.affiliation:  Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo - Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morita
authors.affiliation:  Department of Plastic Surgery, Tokyo Women's Medical University, Tokyo - Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation:  Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo - Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D001170:Arthritis, Infectious / Q000601:surgery*; D001182:Arthroscopy; D001419:Bacteria / Q000302:isolation & purification; D003646:Debridement; D005260:Female; D006621:Hip Joint / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000637:transplantation*; D018570:Risk Assessment; D007507:Therapeutic Irrigation; D016896:Treatment Outcome