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J Orthop Case Rep. 2016 Jul-Aug;6(3):3-6. doi: 10.13107/jocr.2250-0685.472.

Bilateral prosthetic hip joint infections associated with a Psoas abscess. A Case Report.

Author information

1
Department of Orthopaedic Surgery Registrar Royal Perth Hospital, Perth, Australia.
2
Department of Computer Science and Engineering, Curtin University of Technology, Perth, Australia; The University of Notre Dame, Perth, Australia; The Joint Studio, Perth, Australia.
3
Hollywood Private Hospital, Perth, Australia.
4
Department of Infectious Diseases, Sir Charles Gairdner Hospital, Perth, Australia.

Abstract

INTRODUCTION:

Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections.

CASE REPORT:

We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip. He then developed an infected right thigh haematoma, which also formed a discharging sinus connecting to the right hip post-drainage. He was treated with bilateral two-stage revision total hip arthroplasties and multiple courses of prolonged antibacterial therapy. Both abscesses and hip joints cultured the same species of multi-sensitive Staphylococcus aureus. The causal link between the psoas abscess and the prosthetic hip infections is discussed, as well as the investigation and management.

CONCLUSION:

We recommend routine exploration of the iliopsoas bursa when revision of an infected total hip arthroplasty is performed to rule out intrapelvic spread of the infection [3]. There should be high index of suspicion of prosthetic hip infection in patients presenting with Psoas abscess and vice versa. A CT scan might be warranted to rule out concomitant infection in both these patients.

KEYWORDS:

Psoas abscess; hip arthroplasty; prosthetic hip joint infection

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