Septic arthritis of the hip and osteomyelitis of the upper end of the femur in infants.

This paper is a review of nine children who had a septic arthritis of the hip and who can be accepted as examples of Tom Smith’s disease or acute arthritis of infancy, with one other example of an extensive osteomyelitis of the femur in an infant. A review of the literature suggests that it is not a very common disease and a report of a small personal series may prove useful. Every study of this subject should start with Thomas Smith’s classical review of septic arthritis of infancy in I 874. His study was not confined to any one joint and included thirteen fatal cases in which he made a careful post-mortem examination of the joints, from which he concluded that the septic arthritis usually resulted from the rupture into the joint of a metaphysial, or occasionally an epiphysial, abscess; in other words, that the process usually began as an osteomyelitis. Among his eight surviving patients were three with a persisting dislocation after a septic arthritis of the hip. He was the first to realise that a haematogenous osteomyelitis or arthritis of infancy, when not fatal, recovered rapidly with no persisting sinuses and no late complications-in contrast to the relapsing osteomyelitis which was usually expected in those days in older patients.