A devastating complication from neonate knee septic arthritis due to conservative treatment: A case report

INTRODUCTION: Septic arthritis in the neonate is a devastating condition that affects children and causes irreversible limb dysfunction or deformity. Neonatal septic arthritis is harmful and will end with skeletal abnormalities. PRESENTATION OF CASE: Neonate born with ileal atresia and underwent surgical treatment. Postoperatively, the patient experienced sepsis and was accompanied by septic arthritis. The patient was given triple IV antibiotic treatment without surgical debridement. Ten months later the deformity became prominent with physeal destruction of the affected area at distal femur. At age six the patient came to the orthopaedic outpatient clinic and there was a 3 cm limb-length discrepancy of both legs. DISCUSSION: Early diagnosis of septic arthritis is critical for successful treatment, since neonates with delayed proper diagnosis have been shown to have poor long-term prognosis. In our case the patient was only managed by IV antibiotics administration and continued with oral antibiotics. The reason for this decision due to general condition was improved after medication although clinically he still has a small amount of knee swelling. CONCLUSION: Neonatal septic arthritis is dangerous and may have a devastating long term complication. Surgical management should be considered as treatment of choice if there is a lack or no progression from clinical and laboratory examination after antibiotic adiminstration. Growth arrest on the distal femur will result in leg length disparity and angular deformity.