Functionality Against Odds: Lower Extremity Functional Scale and Children Health Assessment Questionnaire in Children with Bilateral Septic Sequelae of Hip

Volume 9 | Issue 1 | January-April 2023 | Page: 21-25 | Abdus Sami, Anil Agarwal, Lokesh Sharma., Yogesh Patel, Varun Garg 

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.151


Authors: Abdus Sami [1]  MS Orth., Anil Agarwal [1] MS Orth., Lokesh Sharma [1] MS Orth., Yogesh Patel [1] MS Orth., Varun Garg [1] MS Orth.

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Address of Correspondence

Dr. Anil Agarwal,
Specialist, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: anilrachna@gmail.com


Abstract

Purpose: We assessed the functional and radiological outcomes of children with sequelae of bilateral septic hips. Additionally, we attempted to determine the impact of radiological unstable hips on clinical functionality of the child.
Material and methods: The retrospective case series included 9 children minimum 2 years post infection. The functional outcomes were assessed using Lower Extremity Function Score (LEFS) and Children Health Assessment Questionnaire (CHAQ). Follow up hip radiographs were classified according to the Choi’s classification. We labelled the patient as having instability if either hip had a Choi type >3A.
Results: The mean age at final follow-up was 7.6 years. Five patients had multiple joints affection. The mean LEFS score was 62.7 and CHAQ-DI 0.2. The mean LEFS values for radiological stable hips (n= 5 patients) was 66 ± 19.4 and 58.5 ± 15.3 for unstable hips (p=0.5487) while corresponding CHAQ-DI scores were 0.12 ± 0.13 and 0.27 ± 0.12 respectively (p=0.1098) indicating poor relatability between functional capabilities of the child and the radiological appearances of the hips. A strong negative correlation however existed between LEFS/ CHAQ-DI values (R= -0.897; p=0.001).
Conclusions: Septic hip sequelae in children leads to various degrees of functional limitations and patients with multiple joint involvement have worse outcomes. The hip radiological findings do not relate with the overall functional status of the child.
Keywords: Functional outcome, Disability, Hip, Sepsis, Child


References

1. Arkader A, Brusalis C, Warner WC Jr, Conway JH, Noonan K. Update in pediatric musculoskeletal infections: when it is, when it isn’t, and what to do. J Am Acad Orthop Surg.2016;24:e112-21.
2. Howard JB, Highgenboten CL, Nelson JD. Residual effects of septic arthritis in infancy and childhood. JAMA.1976;236:932-5.
3. Samora JB, Klingele K. Septic arthritis of the neonatal hip: acute management and late reconstruction. J Am Acad Orthop Surg.2013;21:632-41.
4. Mue D, Salihu M, Awonusi F, Yongu W, Kortor J, Elachi I. The epidemiology and outcome of acute septic arthritis: a hospital based study. J West Afr Coll Surg.2013;3:40-52.
5. Nunn TR, Cheung WY, and Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg Br.2007;89:100-6.
6. Kini AR, Shetty V, Kumar AM, Shetty SM, Shetty A. Community-associated, methicillin-susceptible, and methicillin-resistant Staphylococcus aureus bone and joint infections in children: experience from India. J Pediatr Orthop B.2013;22:158-66.
7. Narang A, Mukhopadhyay K, Kumar P, Bhakoo ON. Bone and joint infection in neonates. Indian J Pediatr.1998;65:461-4.
8. Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequelae and reconstruction after septic arthritis of the hip in infants. J Bone Joint Surg Am.1990;72:1150-65.
9. Forlin E, Milani C. Sequelae of septic arthritis of the hip in children: a new classification and a review of 41 hips. J Pediatr Orthop.2008;28:524-8.
10. Agarwal A, Rastogi P. Septic sequelae of hip in children: long-term clinicoradiological outcome study. J Pediatr Orthop B.2021;30:563-71.
11. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther.1999;79:371-83.
12. Singh G, Athreya BH, Fries JF, Goldsmith DP. Measurement of health status in children with juvenile rheumatoid arthritis. Arthritis Rheum.1994;37:1761-9.
13. Agarwal A, Kumar Kh V. Suppurative arthritis of hip in a walking child: Effect of patient’s age, delay in surgical drainage, and organism virulence. J Orthop Surg (Hong Kong).2020;28:2309499020910974.
14. Dingemans SA, Kleipool SC, Mulders MAM, et al. Normative data for the lower extremity functional scale (LEFS). Acta Orthop.2017;88:422-6.
15. Sontichai W, Vilaiyuk S. The correlation between the Childhood Health Assessment Questionnaire and disease activity in juvenile idiopathic arthritis. Musculoskeletal Care.2018;16:339-344.

 


How to Cite this Article: Sami A, Agarwal A, Sharma L, Patel Y, Garg V | Functionality Against Odds: Lower Extremity Functional Scale and Children Health Assessment Questionnaire in Children with Bilateral Septic Sequelae of Hip | International Journal of Paediatric Orthopaedics| January-April 2023; 9(1): 21-25 | https://doi.org/10.13107/ijpo.2023.v09.i01.151

(Article Text HTML)      (Full Text PDF)