Sequelae of septic epiphysitis of the hip

The catastrophic sequelae of delayed diagnosis of septic arthritis of the hip are a consequence of destruction of the articular hyaline cartilage and irreversible damage to the epiphysis, physis and metaphysis of the proximal femur and occasionally the triradiate cartilage of the acetabulum.The various clinical and radiological sequelae of septic arthritis of the hip are coxa magna, avascular necrosis of femoral head, acetabular dysplasia, subluxation/ dislocation, abductor insufficiency/trochanteric overgrowth, coax vara/coax valga, torsional deformity, leg length discrepancy, pseudoarthrosis of femoral neck, and complete destruction of femoral neck& head, ankylosis of the hip. The sequelae were first classified by Hunka et al. on the basis of their radiological appearances.The treatment strategies include conservative measures to maintain hip mobility in mild deformity, realignment proximal femoral osteotomies to correct varus/valgus deformities, pelvic osteotomies (Pemberton/Dega acetabuloplasties) to address acetabular dysplasia and instability, trochanteric distal transfer for abductor insufficiency plus the various measures to address the consequences of significant leg length discrepancy. Gross deformity and instability arising from a complete destruction of femoral head and neck (Hunka Type V hips) remain a challenge, and recent reports have indicated reasonable results with Pelvic Support Osteotomy along with Ilizarov hip reconstruction.