A study of the end results (Tables XI and XII) of the treatment of the subacute and chronic septic hip joints, with which this paper deals almost entirely, shows a relatively low death rate and a high frequency of healing of the infection. From this standpoint the results are satisfactory, but of the 113 cases there were only seven in which the hip was normal. Twenty-three patients with septic arthritis had a functional joint with at least 50 per cent. of normal motion. The remaining eighty-three cases demonstrated numerous severe complications, resulting in irreparable functional damage to the hip joint proper. The poor prognosis in cases in which there are complications such as dislocation of the hip, sequestration of the head, and epiphysiolysis, is readily confirmed by the results in this paper. Inasmuch as neither dislocation of the hip, with the exception of two cases, nor epiphysiolysis developed while under our care, we feel that they are preventable complications in the most part if an arthrotomy is performed early in the course of the disease and if the hip is fixed in mild abduction and extension by traction or plaster.
The results here recorded point to a more favorable prognosis in the case of a primary synovial lesion, whether due to streptococcal or staphylococcal infection. If the patient survives the acute infection, rapid healing with good motion and no recurrence is the rule. If the lesion is primarily osteomyelitic in origin, the prognosis is much poorer and early and radical surgery is necessary. The age of the patient plays a definite part in the type of lesion and is of importance from a prognostic and therapeutic standpoint. Under two years of age, there is very good expectation that the lesion is primarily synovial; under five years, without evidence of bone infection, the prognosis is good. Between six and eighteen years is the period of the greatest number of complications. It is during this period that osteomyelitis most commonly develops, and the prognosis for function is much poorer.
(C) 1936 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.