Native hip joint septic arthritis in 20 adults: Delayed presentation beyond three weeks predicts need for excision arthroplasty

SummaryObjectivesSeptic arthritis of native hip joints is an uncommon condition in adults in Western Europe, but continues to present a challenge to medical and surgical management. We set out to study the natural history and bacteriology of the disease in this group, with a particular focus on patients requiring excision arthroplasty (EA).MethodsWe retrospectively studied 26 secondary referral cases (20 adults) managed by a specialist bone infection unit over a 12 year period.ResultsOur patient cohort was diverse, affecting all age groups in the presence and absence of co-morbid conditions. The commonest pathogen was Staphylococcus aureus. Of 20 adults studied, five (25%) required EA. Symptom duration prior to presentation was a statistical predictor of the requirement for EA (p < 0.003); in particular, symptom duration of over three weeks was strongly associated with requirement for this procedure (p < 0.0003).ConclusionsIn cases that present promptly, combined surgical drainage and intravenous antibiotics should be expected to eradicate infection and to salvage the femoral head. Cases presenting following a delay are more likely to require EA and subsequent hip reconstruction.