Hip Disarticulation for Severe Lower Extremity Infections

Hip disarticulation is rarely performed for infections and variable mortality rates have been reported. We determined the number of deaths following hip disarticulation for severe lower extremity infections in 15 patients. Indications for hip disarticulation were necrotizing soft tissue infections in seven patients and persistent infections of the proximal thigh in eight patients. The most common microorganism was Staphylococcus aureus, present in eight patients. Hip disarticulation was performed emergently in seven patients and electively in eight patients. All patients survived the operation and at 1 month postoperatively 14 of 15 patients were alive. Hip disarticulation for these severe infections had high survival, even when performed emergently for life-threatening infections. We believe hip disarticulation is a reasonable option treating severe infections of the lower extremity and should be part of the armamentarium of the orthopaedic surgeon

Magnetic Resonance Imaging Findings in Hematogenous Osteomyelitis of the Hip in Adults

Hematogenous hip infections are rare in adults and the extent of infection into the bone or adjacent soft tissues may be underestimated, leading to inadequate surgical débridement. Using MRI, we sought to determine the extent of bone involvement and the presence of adjacent soft tissue abscesses in adults with hip osteomyelitis. We reviewed the records and MRIs in 11 adult patients (12 hips) with hematogenous osteomyelitis of the femoral head in 12 hips. Ten of 11 patients had one or more comorbidities. All patients underwent surgical débridement and received antibiotic therapy for 6 weeks. MRI revealed osteomyelitis distal to the femoral head in seven of 12 hips with extension into the medullary canal in three of these seven. Femoral head erosions were present in 10 hips, acetabulum osteomyelitis in 11, and acetabular erosions in six hips. Infection extended into adjacent soft tissues in eight of 12 hips. MRI demonstrated that the infection may extend distal to the femoral head or into the adjacent soft tissues. MRI may be useful for preoperative planning so that all regions affected by the infection can be treated