Postinfectious Deformities of the Lower Limb

There is a diverse range of residual deformities following septic arthritis and osteomyelitis of the pediatric lower limb. Most of the postinfectious juxta-articular and articular deformities of the lower limb arise from complex pathology, often related to delayed treatment and suboptimal surgical intervention. These deformities are usually associated with partial or complete loss of intra—or juxta-articular osteocartilaginous structures, or physeal growth disturbance following septic arthritis of the hip, knee, and ankle, and osteomyelitis of the femur and tibia. Affected children often present with clinical problems such as pain, limp, joint instability or contracture, restriction of motion, and even emotional disturbances. Functional disabilities are enormous, especially in children with severe, multifocal residual angular and/or rotational deformities, often associated with limb length discrepancy (LLD). The ultimate surgical goals in the management of postinfectious deformities of the lower limb are to relieve current symptoms, and to prevent premature osteoarthritis secondary to the deformity by restoring the weight-bearing mechanical axis and by optimizing the joint mechanics at skeletal maturity. Deformity analysis via a thorough musculoskeletal physical and radiological assessment is of paramount importance for achieving successful results of lower limb reconstruction. The decision to perform either a reconstructive procedure or a salvage procedure must be made on an individual basis after having considered multiple variables, including age, type of sequelae, joint stability and motion, presence of a lurch, history of failed previous reconstructive surgery, and LLD. Acute correction of the deformity is preferable but cannot always be achieved. In such cases, gradual correction using distraction osteogenesis is a viable option.