Summary: | <p><strong>Background</strong>: Surgical management of septic arthritis (SA) of the hip aims at
treating the infection by either preserving, resecting or replacing the
joint. In some cases, joint preservation should be attempted, whereas other cases would
benefit from immediate joint resection or replacement. Prognostic factors
have been proposed to guide decision-making. We hypothesized that most of
these factors can be simplified to three subgroups based on the route of
infection: contiguous spreading, direct inoculation or hematogenous
seeding. <strong>Methods</strong>: A total of 41 patients have been treated surgically for SA of the native
hip at our tertiary hospital during the last 16 years. Medical records were
studied, and various patient and disease characteristics were collated.
<strong>Results</strong>: Significant differences between (1) level of fitness, (2) condition of
the hip joint, (3) micro-organisms and (4) chance of femoral head
preservation were found for patients with SA of the native hip resulting
from the three aforementioned subgroups. Femoral head resection was necessary at one point
in 85 % of patients. Patients with hematogenous infections of undamaged
hips had a reasonable chance (53 %) of avoiding joint resection or
replacement. Hip arthroplasty was performed on 46.3 % of patients, with an
infection rate of 10.5 %. <strong>Conclusion</strong>: Patients with SA of the native hip
resulting from contiguous spreading, hematogenous seeding or direct
inoculation differ significantly and should be considered distinct clinical
entities. Route of infection is directly related to the chance of femoral
head preservation and should, therefore, guide decision-making. Only patients
with hematogenous infection to a previously healthy hip had the possibility of
femoral head preservation.</p>
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