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At least 19 recordsLinked to original sources
PubMed1992

[The painful hip joint in the child: differential diagnosis and therapy of coxitis fugax, Perthes disease and septic coxitis].

The differential diagnosis of a painful hip joint in children is important. Transient synovitis is frequently seen in children from 3 to 7 years of age with a short history of limping. The joint effusion is visualized by ultrasound. Radiograms and laboratory data are negative. Therapy consists of short term bed rest supported by an oral antiphlogistic drug. Children with Legg-Calve-Perthes disease complain about knee or hip pain in an early stage. X-ray documentation in the a.p and axial view are mandatory as well as ultrasound visualization of the accompanying effusion. Healing of the capital femural epiphysis is aided by weight relief and improved head containment. This may need from one to three years according to the age of the child and the amount of head involvement. More than half of the children's hips with Perthes disease surgical help to achieve a satisfactory result. Hip pain is overwhelming in cases of septic arthritis of the hip joint. This is the most important help to differentiate septic coxitis from transient synovitis or Perthes disease. Rapidly rising values of red cell sedimentation and c-reactive protein are important for early diagnosis. Septic effusions are visualized by ultrasound. X-ray changes are absent in the beginning and are seen only in delayed cases. Early arthrotomy with scrupulous rinsing of the joint, followed by parenteral antibiotic treatment, is the treatment of choice.

Arthritis, Infectious↗
PubMed2002

The efficacy and safety of intraarticular corticosteroid therapy for coxitis in juvenile rheumatoid arthritis.

OBJECTIVE: To study the efficacy and safety of intraarticular triamcinolone hexacetonide (IATH) for the treatment of coxitis in patients with juvenile rheumatoid arthritis (JRA). METHODS: Fifty consecutive patients with JRA and coxitis were studied prospectively. Forty-eight children received IATH in 67 arthritic hips. The remaining 2 children exhibited 3 cases of femoral head necrosis (FHN) at the initial assessment and were only followed up; both were receiving long-term systemic steroids. After a minimum of 2 years, the study was concluded with a final evaluation that included magnetic resonance imaging. RESULTS: In 39 of 67 hip joints (58%), remission of the coxitis for a period of 2 years was obtained through a single administration of IATH, while another 12 hip joints showed remission of coxitis after repeated TH injections (total remission rate 76%). We observed 2 patients with FHN following IATH. Both of these children were receiving long-term systemic steroids. During the period between onset of JRA and screening assessment for this study, the children exhibited 2.4 cases of FHN per 100 patient-years, while 1.5 cases of FHN per 100 patient-years were observed between IATH treatment and final followup. All 5 observed cases of FHN occurred among the 20 children who received long-term systemic steroids, while no necrosis occurred in the 30 children who did not receive systemic corticosteroids (P = 0.009 by Fisher's exact test). CONCLUSION: IATH for juvenile rheumatoid coxitis was an effective treatment that did not increase the rate of FHN. Systemic steroids, however (or their covariable, severity of JRA), may increase the risk of FHN in JRA.

Adolescent↗
PubMed1988

Carrageenan-induced coxitis in puppies.

We studied the influence of chronic synovitis and joint effusion on the blood supply and growth of the immature femoral head in 12 puppies. Twelve weekly intraarticular injections of Carrageenan solution caused unilateral coxitis with caput magnum formation. Joint pressures in the neutral position were 0.9 kPa in the coxitis hips and -0.5 kPa in the contralateral hips. The joint capsule in coxitis showed hyperemia as measured by tracer microsphere technique. In nonmedicated, awake, standing dogs there was hyperemia of both the femoral head epiphysis and the joint capsule. In all the dogs, acetabular and proximal femoral metaphyseal blood flow was unchanged. In the control group, repeated cannulation and injection of normosaline did not change the hemodynamics, joint pressure, or femoral head size. We found no evidence of femoral head ischemia in coxitis with moderate chronic elevation of resting joint pressure.

Animals↗
PubMedDate not supplied

Migration of the femur head in rheumatoid coxitis.

The direction of penetration of the destroyed femoral head into the acetabulum in rheumatoid coxitis has been determined by means of the method of geometrical analysis in 81 affected hip joints. Of 48 patients, the duration of coxitis was 1-17 years (mean 4 years). Displacement of the femur head, destroyed by rheumatoid inflammation, was expressed in millimeters by means of a geometrical parameter called "transposition of the center of the femur head". The direction of transposition of the femur head into the deepened acetabulum has been expressed quantitatively by authors making use of the new geometrical parameter "the angle of transposition of the center of the femur head" which is referred to as angle delta. The angle delta is an angle between the line of transposition of the femur head center (tC) and its vertical component. The mean value of the delta angle for the entire group investigated measured 27.6 degrees and ranged from -5 degrees to +54 degrees, whereby an angle of 0 degrees marked the cranial direction of transposition, positive values marked the craniomedial transposition direction of the femur head. The angle delta varied from 21 degrees to 40 degrees in the majority of affected hip joints. The values of the delta angle were constant in every hip joint, thus indicating that the direction of transposition of the femur head did not change in the course of the progression of rheumatoid coxitis. It was found and statistically confirmed that no reciprocal dependence existed between the rate of progression of coxitis and the direction of displacement of the femur head into the acetabulum.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMedDate not supplied

[Transient hip joint inflammation (coxitis fugax)].

The transient coxitis is the most common hip disease in the childhood. Etiology is unknown. Questioning the history you will often find an infection in the neck, nose, ear area. Clinical, radiological findings and serological testing are unspecific. In the arthrosonography normally you will find an effusion. The positive diagnosis of the transient coxitis is only possible by observing the mostly benign course of the disease. The treatment is bed rest and non weight bearing. The most important differential diagnosis is the Perthes disease. The principal aspects of the transient coxitis are described and discussed in literature and by own experience.

Adolescent↗
PubMed1991

[Purulent coxitis with hip luxation and acute peritonitis].

A boy aged five months was admitted to a hospital elsewhere on account of failure to thrive for three weeks and intermittent pyrexia. X-ray revealed dislocation of the right hip. After attempted reduction, the infant developed peritonitis. Laparotomy revealed pus which originated from purulent coxitis draining through a defect at the base of the acetabulum. Arthrocentesis should be performed in children with acute coxitis and high fever. If pus or cloudy joint fluid is obtained, the hip joint should be opened and drained at the same session. Neglected purulent coxitis results in destruction of the joint and prolonged incapacity which was the result in the case reported here.

Acute Disease↗
PubMedDate not supplied

Prognosis of rheumatoid coxitis.

Geometrical analyses of the anteroposterior X-rays of 81 hips affected by rheumatoid arthritis for 1 to 17 years, have shown that the rate of progression of the inflammatory destructive lesions in the hip, expressed quantitatively in millimeters per year, depends on the local anatomical relations in the coxofemoral joint itself. This relationship is expressed by the angle of penetration of the plane of the acetabular opening (PEC) (angle PEC = angle CCD + angle n - angle PE). The PEC angle was found to be within the range of 85 to 128 degrees, and its mean value for the whole group was 104.6 degrees. In hips affected by rheumatoid arthritis for the same period of time, the average rate of progression of coxitis was twice as high when the PEC angle was up to 104 degrees than when it was 105 or more degrees. This difference is statistically significant. Irrespective of the magnitude of the angle of penetration through the plane of the acetabular opening (PEC), coxitis was found to progress the most rapidly during the first years of hip affection, and to diminish thereafter along a parabolic curve. The knowledge gained in this study makes it possible to predict the rate of progression of coxitis and is a contribution to a better clinical and radiological understanding of rheumatoid arthritis of the hip joint.

Acetabulum↗
PubMed2003

Salmonella enteritidis causing brain abscess and coxitis following intracranial surgery.

We report the case of a 46-year-old woman who underwent surgery for an adamantinous craniopharyngeoma (WHO grade I). The postoperative course, during which the patient received 16 mg/day of dexamethasone, was initially uneventful. After a fortnight the patient developed infectious signs and an intracranial abscess at the operation site with simultaneous purulent coxitis. Both the intracranial abscess and the coxitis were evacuated and drained. In tissue samples and pus obtained during re-craniotomy and during surgery on the hip, Salmonella enteritidis was detected by cultivation. Salmonella enteritidis was also isolated from several stool specimens. There was no known salmonellosis in the patient's medical history. She recovered as a result of antibiotic treatment with ciprofloxacin and chloramphenicol. The intracranial abscess healed without leaving any neurological deficit. Unfortunately the left hip subsequently required further surgery, culminating in removal of the entire femoral head. Prosthetic replacement could not yet be performed due to the recurrent septic course of the hip. Our case illustrates a serious complication with presumed haematogenous spread of the infection from a pre-existing asymptomatic and unknown colon infection. The immunosuppressive effect of corticosteroids in the treatment of the brain neoplasm might have been a contributing factor to the sudden exacerbation of the latent infection.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Coxitis fugax--the beginning of Perthes' disease?].

We present the clinical case of a decennial boy with acute leftsided hip pain without appropriate trauma. The initial diagnosis of coxitis fugax was verified in this case with inconspicuous blood parameters and X-ray by a sonographically proven intraarticular effusion. An immediate magnet resonance imaging (MRI) study of the affected hip joint was done. Here, a complete "necrosis" of the proximal femur epiphysis was verified. With knowledge of these results, an immediate operation of the hip joint with a ventral capsule incision and consecutive intraarticular decompression was performed. A complete reperfusion of the femur head was evident in the MRI scan seven days postoperatively. In accordance with this clinical case report, we would like to point out the necessity for the immediate diagnosis of indifferent hip pain by means of MRI, especially for patients in the atypical "critical age" (> or = 8 years) for coxitis fugax. This is discussed under consideration of the possible aetiopathogenesis and the current literature.

Arthralgia↗
PubMed2003

[Suppurative coxitis after a viper bite--case report].

A 46-year-old woman having sustained a rhinoceros viper bite to the left lower leg is presented. She was treated at Department of Infectious Diseases, Split University Hospital. After 20 days she left the hospital in good condition, with a small crust at the bite site. About ten days later suppurative secretion developed at the bite site and a few days later she felt pain in her right hip and leg, and turned febrile. She was treated at home with antibiotics and analgetics for nearly one month. Her condition was worsening, and she was referred to Department of Neurosurgery, for suspected lumboischialgia. Then, she was transferred to the Department of Orthopedics as suspected septic coxitis, where she was operated on. The disease was not recognized on time, appropriate treatment was introduced too late, and irreparable consequences developed in the right hip. To the best of our knowledge, this is the first reported case of coxitis, especially on the contralateral side to the snake bite. Infection from the site of snake bite on the left lower leg could have been transferred to the right hip exclusively by hematogenous way. Our objective is to warn of this rare snake bite complication, and to contribute to better diagnostic and therapeutic management in similar situations.

Animals↗
PubMed1991

[Coxitis in Reiter's disease: the problems of diagnosis and differential diagnosis].

Based on analysis of the data on 124 patients with significant diagnosis of Reiter's disease, coxitis was discovered in 38 (30.8%) of them. During examination, the early clinical signs were revealed to diagnose any coxitis as were differential diagnostic signs to delineate lesions of the hip joints in seronegative arthritis and/or spondylarthritis (Reiter's disease, ankylosing spondylarthritis and psoriatic arthritis), having an analogous clinico-roentgenologic appearance.

Adult↗
PubMed1987

[Treatment of suppurative coxitis].

An experience with the treatment of purulent coxitis in 56 patients is described. Acute coxitis was treated by arthrotomy, sequestrectomy and antibacterial therapy. Chronic forms of osteoarthritis consisted in the surgical treatment of the purulent focus and filling the cotyloid cavity with a muscular flap or the proximal end of the femoral bone.

Adolescent↗
PubMed1998

Total hip arthroplasty in Salmonella coxitis: four cases report.

Suppurative coxitis induced by salmonella is rarely reported in the literature. Furthermore, reconstruction with a total hip arthroplasty (THA) in such patients has never been reported. However, in this study, we present 4 cases; 2 normal male patients and 2 female patients with underlying systemic lupus erythematosus (SLE). The ages range from 26 to 61 years. All 4 cases revealed growth of group B salmonella from the cultures of synovial fluid. They all received THA after the infections were eradicated. The functional assessment of pain, range of motion, walking ability together with the radiographic assessment were used according to the new hip score system. After a minimum follow-up of 2 years, all of the reconstructed hips showed good to excellent results since no infections recurred during this period. Although the long-term results are uncertain, the short-term clinical advantage of THA in the treatment of quiescent salmonella coxitis is encouraging.

Adult↗
PubMed1978

[The therapy for pyogenic coxitis and its stabilisation with the fixateur externe (tubular system) (author's transl)].

The treatment of the destructive, unstable state of infection on the hip often takes an unfavourable course, because alloarthroplastic techniques are ruled out on principle, while the hip arthrodesis itself creates biomechanical problems under the incomparably more favourable aseptic conditions. The protracted trimming arthrodesis with immobilisation by pelvic plaster cast remains precarious with regard to the painful stress and the sedation of the infection, and it always includes the danger a damage causing immobilisation of the knee joint. The jointparts destructed by the infection are equivalent to an infected pseudarthrosis; for its stabilisation the fixateur externe is indicated, by analogy to the approach used on the extremities. The biomechanical problems are similar to those occuring with the internal fixation of hip arthrodesis: neutralisation of dislodging forces on the long leg lever, reliable anchorage of the means of osteosynthesis on the pelvis and axial compression on the broadest possible contact surfaces of the anthrodesis. A special installation of the fixateur externe (tubular system of the ASIF) is pointed out, which meets almost all requirements. The external osteosynthesis joins lateral ilium and femur shaft, compressing the hip area. For securing the stability it is necessary to include both of the iliac crests and a diagonal brace in the outer construction. The external fixation for stabilising the hip represents a large-scale technique which, by its nature, is inferior to internal osteosynthesis. But for the treatment of active pyogenic coxitis neither the arthrodesis by copra-head-plate nor the screw joint in connection with intertrochanteric osteotomy is suited. The advantages in contrast to the classical therapy with pelvic plaster cast are obvious. The operating method is explained on a model and presented in a casuistry on 3 people operated on so far. If the head-neck-segment is lost completely after septic head necrosis, a careful debridement and the Girdlestone-plastic usually lead to an infection sanitation, but mostly at the cost of an unstable hip on the considerably shortened leg.

Adult↗