Resection arthroplasty for septic arthritis of the hip in ambulatory and nonambulatory adult patients.

Twenty-three patients who required resection arthroplasty because of pyogenic infection of a hip joint were reviewed. Nine of the patients were ambulatory, and the others were either paraplegic or bed-ridden because of chronic neurologic disease. The average duration of symptoms was more than two months. The only consistently abnormal laboratory test was the erythrocyte sedimentation rate (ESR). Joint-space narrowing and bone erosion due to osteomyelitis were the most common roentgenographic findings. Different microorganisms were isolated from the different cases, but Staphylococcus aureus was documented in eight hips. Femoral head dislocation of subluxation was documented in 11 of 24 hips. Osteoarthrosis or osteonecrosis was a preexisting condition in only four hips, all in ambulatory patients. Pathologic findings included loss of articular cartilage by surface erosion and by subchondral bone resorption, resulting in the separation of the cartilage from the underlying bone, bone erosion, osteomyelitis, and segmental osteonecrosis.