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Septic arthritis is a common joint infection in neonates and young children. Since osteoarticular infections cause permanent disability in bones and joints, they should be treated appropriately as soon as possible. If there is a delay in starting treatment it can cause severe morbidity. It is most common in the hip and shoulder joints. In this article the surgical treatment process and postoperative clinical status of a 35-year-old patient with severe coxarthrosis and 12 cm femoral shortening due to septic arthritis are reported. To avoid damage to neurovascular structures an extremity lengthening procedure was performed first, followed by a total hip replacement. In order to complete the distraction and consolidation phase in one session and to reduce complications, a growing intramedullary nail was selected. As a result of the surgical interventions, the complaints of the patient in the hip joint and the limping due to shortness of the leg decreased and the performance of activities of daily living was improved.

Pathologies of the hip, spine and the lower extremity are often concomitant due to their three-dimensional anatomic and physiological interrelation. The real challenge lies in defining which of the pathologies is most relevant for the patient in terms of clinical symptoms and which organ should be treated first. The purpose of this review article is two-fold: Firstly, to explain the treatment dilemma of hip-spine syndrome to the treating physician. Secondly, to highlight the significance of spinal pathology in this context.

Background: Avascular necrosis of the femoral head is a progressive perfusion disorder of the hip joint. Progress in avascular necrosis causes structural damage to the affected joint, often requiring total hip replacement., Aim: This article is intended to give the reader an overview of the current literature on total hip replacement of patients with an avascular necrosis of the femoral head., Results: Before 1990, patients with avascular necrosis of the femoral head had significantly higher revision rates after total hip replacement. Recent studies, however, showed no significant differences in clinical outcomes after total hip replacement in femoral head necrosis and primary osteoarthritis. Despite the young age of the patients, good long-term clinical results can be expected even in patients with an avascular necrosis of the femoral head after total hip replacement.

In patients with hip pain, clinical examination is of only restricted value in the differential diagnosis. Besides a patient's age, their medical history is often helpful in finding the correct diagnosis. Additionally, imaging can give valuable hints for excluding or validating a differential diagnosis. Nowadays, magnetic resonance imaging (MRI) is often used as a primary imaging modality in Germany. These MRIs show a bone marrow edema (BME) in many different pathologies. BME occurs in transitory bone marrow edema and outside of the atraumatic femoral head necrosis, concomitant with coxarthrosis, arthritis, herniation pit, and osteoid osteoma, amongst other conditions. This article describes several frequent differential diagnoses and gives hints on how to find the correct diagnosis.

Dislocation of the hip is rare and so we regard every hip dislocation as an emergency until it has been reduced. From 1977 to 1996 a total of 82 patients with hip dislocation were treated at the Traumatic Surgery Clinic, University of Vienna, Austria. The average age at injury was 29 years. Some 77 patients had unilateral dislocation of the hip, but only in 5 cases was bilateral dislocation found. Iliac dislocation was most common (54 patients). Our treatment consisted in reduction within 6 h of the injury under general anaesthesia (Böhler) and 14 days bedrest. Then the patients were mobilized with full weight bearing, depending on the pain. Of the patients 29 had no clinical infirmities, 8 patients reported temporarily occurring pain and in 6 patients we found a limited range of movement in the hip joint with occasional pain. In all, 43 patients were followed up after 1 / 2 to 19 years. Radiological signs were seen in 17 patients and avascular necrosis of the femoral head in 1.So after careful evaluation of the patients and the kind of treatment, we recommend the following:1. Immediate, gentle reduction of the hip joint2. Bedrest for 14 days3. Early mobilization with full weight bearing.