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Adult dysplasia of the hip as a sequlae of infantile septic arthritis
HPI
Since her last operation (7years ago) the patient describes occasional mild discomfort/dull pain in her left groin (3/10 VAS). Over the course of time her symptoms are stable. The pain sometimes radiates to the left greater trochanter. Her symptoms are aggravated when sitting or standing upright for a long time (>30 minutes or 1km walking) and sometimes when lying on her left side. She rarely has night pain. She refrains from exercise as it can exarcebate her symptoms. She rarely takes painkillers(paracetamol). She rarely also feels some discomfort in her lower back after standing upright for a long time. Currently, her condition does not restrict any of her daily activities, although she takes some precautions. She would like to undergo an operation if it could offer her some relief of her symptoms and maybe delaying a hip arthroplasty. Nonetheless, she is aware of the complexity and uncertainty of the outcomes of hip preserving operations. She also considers following conservative treatment until her symptoms become more prominent and then undergo hip arthroplasty given the fact that the outcomes will be superior.
PMH
Normal menstrual cycle, no regular medication, no history of chronic illness, BMI:18.7kg/m2 Surgical history: 2 weeks old: open irrigation and debridement of septic hip, femoral neck osteomyelitis(staph aureus) followed by abduction bracing for 2 years 2 years old: valgus derotational femoral osteotomy 3 years old: hardware removal 15 years old: greater trochanter distalisation 17 years old: hardware removal
PE
Normal gait. 15mm of shortening of the left leg. There is a long lateral scar over the left hip. ROM of the left hip joint is extension / flexion 10-0-125 °, internal rotation / external rotation 40-0-45 °, abduction / adduction 40-0-25 °. ROM of the right hip joint is extension / flexion 10-0-125 °, internal rotation / external rotation 45-0-35 °, abduction / adduction 40-0-25 °. ROM is not painful. No groin pressure pain, no pain on palpation or tapping of the greater trochanter area. Muscle strength of the hip abductors, adductors, flexors and extensors is 5/5 both sides. One leg stand possible. No pain in the area of the lower spine and sacroiliac joints. FABER test is a slightly restricted on the left compared to the right. FADIR test is unrestricted billateraly. Stinchfield test is negative billateraly. Negative Trendelenburg sign. Peripheral pulses and sensitivity normal billateraly.
Open irrigation and debridement of septic hip, femoral neck osteomyelitis(staph aureus)
