We evaluated the residual deformity and late treatment of thirty-four
hips of thirty-one children who had had septic arthritis when they were
less than one year old. The hips were classified into four groups on the
basis of radiographic changes. Type-I deformity (five hips) involved
transient ischemia of the epiphysis, with or without mild coxa magna, and
these hips did not need reconstruction. Type-II deformity (eleven hips)
included deformity of the epiphysis, physis, and metaphysis, and these hips
needed an operation to prevent subluxation; the goals of the operation
included improvement in acetabular coverage, improvement in abductor
efficiency by epiphyseodesis or transfer of the greater trochanter, and
equalization of limb-length discrepancy by epiphyseodesis of the
contralateral limb. Type-III deformity (five hips) involved malalignment of
the femoral neck, with extreme anteversion or retroversion or with a
pseudarthrosis of the femoral neck that necessitated a realignment
osteotomy of the proximal part of the femur or bone-grafting of the
pseudarthrosis. Type-IV deformity (thirteen hips) included destruction of
the femoral head and neck, with persistence of only a remnant of the medial
base of the femoral neck. In the hips that had a Type-IV deformity, the
complex clinical problems, which included severe limb-length discrepancy
and incompetent articulation of the hip, necessitated operations such as
Pemberton osteotomy, trochanteric arthroplasty, arthrodesis, epiphyseodesis
of the contralateral limb, and lengthening of the ipsilateral tibia. The
functional result was satisfactory in all five hips that had a Type-I
deformity, in seven of eleven that had a Type-II deformity, in three of
four that had a Type-III deformity, and in only four of thirteen that had a
Type-IV deformity.