The sequelae of septic hip arthritis in children: a revised classification and case review.

BACKGROUND

Existing classification systems for sequelae of pediatric septic arthritis of the hip (SAH) are notably complex. This study introduces a simplified radiographic classification-the Xi'an Honghui Hospital Paediatric Orthopaedic Classification (HHPO classification)-designed to enhance accuracy in treatment planning and prognostic evaluation.

METHODS

A retrospective analysis was conducted involving 18 pediatric patients with SAH. Pelvic radiographs were evaluated to assess the structural integrity of the femoral head and neck and their spatial relationship with the acetabulum. Based on these assessments, the HHPO classification was developed. Six independent observers classified each case using both the HHPO and Choi systems. Interobserver reliability and two-week intraobserver consistency were assessed and compared between the two classifications.

RESULTS

The distribution according to the HHPO classification was as follows: Type IA (n=5), Type IB (n=6), Type ID (n=2), Type IIA (n=3), and Type IIB (n=2). The HHPO system demonstrated significantly higher inter- and intraobserver agreement compared to the Choi classification. Clinically, severe hip pain was reported in 5 patients, occasional pain in 2, and no pain in 11. The majority of hips (88.9%) exhibited satisfactory range of motion, and 72.2% were radiologically stable. Earlier onset of infection was associated with more severe sequelae.

CONCLUSION

The HHPO classification is simpler, more reproducible, and demonstrates potential clinical utility for managing pediatric SAH sequelae in this cohort.