SEPTIC ARTHRITIS OF THE HIP IN ADULTS J. H. BULMER, WOLVERHAMPTON, ENGLAND From the Robert Joizes aizd Agnes Hunt Orthopaedic Hospital, Oswestry Septic arthritis of the adult hip is uncommon. Twenty patients were admitted to the Robert Jones and Agnes Hunt Orthopaedic Hospital with this diagnosis in the ten-year period 1954-63, out of a total of 27,263 admissions. Because of its rarity the disease is liable to be wrongly diagnosed, or diagnosed at a late stage when the prospects of complete joint recovery are small. Material-This series consists of fifty adults who were diagnosed as having septic arthritis of the hip (Table I, Fig. 1). TABLE I DETAILS OF FwrY PATIENTS WITH SEPTIC ARTHRITIS CF THE HIP Male Female I.Cft Right Bilateral Averageage Age range 35 15 24 2 387 16 to 78 CLINICAL FEATURES AND DIAGNOSIS Symptoms-Pain in the hip always occurs, and is often referred to the knee. Walking is difficult or impossible. Pyrexia, rigors and malaise occur in patients with acute onsets; an insidious onset is not uncommon, and occurred in nine patients in this series (Cases 22 and 33). Signs-The limb is held flexed and laterally rotated at the hip when the capsule is distended with pus, because in this position the volume of the capsule is greatest (Soto-Hall, Johnson and Johnson 1964). Movements are restricted by muscle . spasm and there is tenderness on palpation ofthejoint. . - Radiology-During the first week or two radiographs ‘ - are normal except for occasional evidence of soft-tissue NUMBER - swelling. Narrowing of the joint space was seen at seven OF . . . . PATIENTS days in one hip and in eight others before the twenty-first day. Osteoporosis is a relatively late sign. Upward 21 subluxation occurs because of loss of articular cartilage, 1 loss ofthe upper part ofthe femoral head and destruction _ _ ._ _ ______ . . . 10-19 2029 30-39 40-49 50-59 60-69 7079 of the acetabular roof, and may occur quite rapidly ; in AGE IN YEARS the absence of splintage or traction dislocation may FIG. 1 follow. Age distribution at the onset of septic Laboratory tests-A polymorph leucocytosis and a raised arthritis. erythrocyte sedimentation rate are usual with septic arthritis of acute onset. The anti- streptococcal or anti-staphylococcal titres are helpful if they are raised. Blood culture is often positive and allows the sensitivity of the organism to be discovered. Aspiration-This is the most valuable single investigation. A white cell count of 25,000-250,000 cells per cubic millimetre indicates septic arthritis even if the subsequent culture is sterile. Differentia! diagnosis-Septic arthritis of acute onset may be confused with gout, avascular necrosis of the femoral head, traumatic synovitis and haemarthrosis. Eight patients in this series had had a previous injury. VOL. 48 B, NO. 2, MAY 1966 289
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