Femoral lengthening after type IVB septic arthritis of the hip in children

Septic arthritis of the hip in the newborn baby can result in severe long-term sequelae in the form of dislocation of the hip, loss of movement, and growth disturbance with leg-length discrepancy. For more severe discrepancies often with concomitant hip dislocation, no good solutions are readily available. This series comprised four patients with Choi's type IVB septic hip sequelae. They all had associated multiple-joint sepsis and resultant major leg-length discrepancies ranging from 6.9 to 14 cm. All underwent distraction lengthening with simultaneous correction of angulation and other deformities of the femur, three with the Ilizarov and one with the Orthofix system. The age at operation ranged from 9 to 13 years, with an average follow-up of 3 years. The overall lengthening achieved ranged from 4.5, 6.8, 12, to 13 cm, with the lengthening index from 24 to 51 days/cm. All hips remained stable, and the loss of range of hip and knee motion was not significant. Other complications included one deep pin-tract infection and one fracture of the callus.