|
|
|
« Back
My seven-year-old niece had a hip infection that went undiagnosed and untreated until it dislocated. She recently came to live with us. The surgeons here are saying she's not an "ideal" candidate for surgery. What does that mean exactly?
|
|
Infection of the hip joint that is undiagnosed and therefore untreated can lead to a condition known as septic arthritis. In young children, dislocation of the septic hip can be a challenge.
For one thing, the hip that is not fully formed can look like it is dislocated when, in fact, it's not. If the growth center of the hip (called the capital femoral epiphysis) is not fully ossified (turned to bone and connected to the femur or thigh bone to form the round femoral head), it can give the hip the appearance of being dislocated.
Before a treatment plan can be determined, the surgeon must know for sure whether the child's hip is truly dislocated or just not fully formed yet with an intact capital femoral epiphysis still in place. X-rays are not enough so that MRI, ultrasound, and/or arthrogram are required.
The goals of stabilizing the hip versus restoring normal anatomy depend on knowing whether the capital femoral epiphysis is present or the hip is dislocated. Treatment decisions are also influenced by the age of the child. For example, children under the age of two may be successfully treated with closed reduction. Open reduction is recommended for children older than that. But children older than six years old are not likely to benefit from open reduction.
Evidence from currently available studies suggest that relocation of the hip is not always the best idea. It can result in chronic hip stiffness, leg shortening, and a definite lurch in the gait (walking) pattern. Patients with oddly shaped femoral heads and poor (thin) articular cartilage from the infection often end up with degenerative arthritis and chronic pain even with hip relocation.
Experts advise that patients should be selected carefully for open reduction and surgical restoration of the hip. A nice, round femoral head of good size is important. Healthy cartilage is a good prognostic factor (meaning surgical treatment is more likely to yield good results). And finally, the patient who does NOT have stiffness before surgery has a better chance of good recovery and positive outcomes.
The informed surgeon will not choose to put the child through surgery if all indications are it will not be successful and could likely make the child worse. Given this information, you may want to ask your surgeon for more details of what would make a child a better candidate for restorative surgery and why your niece does not fall into that category. Don't hesitate to seek a second or even a third opinion but be prepared to hear the same counsel from each one.
|
References:
|
|
|
« Back
|
|
|
|
*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
 | All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission. |
|
