ADULT NATIVE JOINT SEPTIC ARTHRITIS OF THE HIP: A FOURTEEN YEAR MULTICENTRE EXPERIENCE OF 46 CASES

Introduction: Septic arthritis of the hip is an Orthopaedic emergency. While common in the paediatric population, it is rare in adults and little is reported on it. Methods: Retrospective review of cases presenting to Leeds General Infirmary, St James’s University Hospital & York District Hospital over a fourteen year period from 1991–2005. Results: 46 cases identified. The mean age was 43 years and 80% (37/46) of cases were male. Risk factors for sepsis were present in 87% (40/46) and consisted of IVDU in 48% (22/46), DM in 20% (9/46), liver disease in 22% (10/46) and immunosuppressive drugs in 17% (8/46). Rheumatic joint disease was present in 28% (13/46) consisting of rheumatoid arthritis, gout and psoriatic arthropathy in 13% (6/46), 9% (4/46) and 7% (3/46) respectively. The primary sources of sepsis were IVDU in 48% (22/46), unknown in 39% (18/46), line sepsis in 11% (5/46) and psoas abscess in 2% (1/46). All cases presented with the triad of groin pain, constitutional upset and difficulty or inability to weight bear. Examination revealed pyrexia in 57% (26/46) and a painfully decreased range of joint motion in all cases. Laboratory tests revealed a raised white cell count in 57% (34/46) and raised CRP’s and ESR’s in all cases. The most commonly isolated organism was staphylococcus aureus 78% (36/46). Medical treatment consisted of antimicrobial therapy for a mean length of 49 days. Surgical treatment consisted of a mean of 1.8 arthrotomies or arthroscopic hip washouts and debridements in consenting cases- 89% (41/46). Two stage total hip arthroplasty for symptom control was required in 4% (2/46). Outcomes were good with sepsis related mortality of 4% (2/46) and local recurrence of 9% (4/44). Discussion: Septic arthritis of the hip is a potentially serious condition. Timely medical and surgical intervention can lead to good outcomes.