Septic arthritis of the hip: a case report

A 61-year-old female presented to a chiropractic clinic complaining of right hip pain of three days duration. Examination revealed a stiff and painful hip. An AP pelvis radiograph taken on that day did not reveal radiographic signs of hip infection. A diagnosis of hip sprain was recorded. The patient was treated conservatively for 7 weeks with rest, NSAIDS and electrotherapy. Her condition failed to improve with this treatment and deteriorated further. The patient was then referred for an orthopaedic consultation. Results from a technetium-99m-labelled methylene diphosphonate ([^99mTc]MDP) bone scan and a gallium-67 (⁶⁷Ga) bone scan suggested a diagnosis of hip joint infection. Subsequent, radiographs of the right hip revealed marked destruction of the right femoral head and acetabulum. Staphylococcus aureus was isolated following aspiration of the painful hip confirming a diagnosis of septic arthritis. The patient went on to operative treatment and is awaiting a total hip replacement. Septic arthritis of the hip can be easily overlooked, initially, as a possible cause of hip pain. The differential diagnosis of a stiff and painful hip must include septic arthritis.     

Septic arthritis of the atlantoaxial joint: case report

Bacterial epidural abscess formation of cervical spine was rarely seen and all these cases were associated with osteomyelitis of the odontoid process. To the author's knowledge, only 1 case of septic arthritis of the C1-C2 lateral facet joint has been reported in the English literature. A 76-year-old woman presented with progressive neck pain and stiffness in the left side of her neck with fever. Coronal computed tomography clearly demonstrated destructive change of the atlantoaxial joint. Contrast magnetic resonance imaging demonstrated infection of the atlantoaxial joint resulting in epidural abscess formation. Because of lack of neurologic deficit, we treated her with halo-fixation together with appropriate antibiotics administration. The patient was successfully treated with antibiotics and immobilization. Septic arthritis of the lateral atlantoaxial joint should be added to the differential diagnosis of severe neck pain with fever, although it is very rare clinical entity. Early analysis of computerized tomography and magnetic resonance imaging although maintaining a high suspicion for this disease is mandatory to avoid delayed diagnosis and subsequent morbidity.     

Septic knee arthritis after intra-articular hyaluronate injection. Two case reports

Intraarticular sodium hyaluronate injection to treat osteoarthritis is associated with minor side effects. Infections seem uncommon. We report two cases of septic knee arthritis. One patient was an 80-year-old woman who was admitted for Staphylococcus aureus knee arthritis after several intraarticular injections of sodium hyaluronate and corticosteroids. In the other patient, a 78-year-old woman, Neisseria mucosa knee arthritis occurred after a single sodium hyaluronate injection. Faultless aseptic technique is essential when administering hyaluronate viscosupplementation. Patients should be informed of the risk of septic arthritis.     

Septic arthritis of the hip after percutaneous femoral artery catheterization

Infection of the hip joint can cause severe articular damage. Standard treatment of septic arthritis includes surgical débridement and intravenous antibiotics. Options for definitive management in the presence of joint destruction include excision arthroplasty, arthrodesis, and total hip arthroplasty. Two cases of septic arthritis of the hip as a complication of femoral artery cannulation are presented. These cases highlight a potential complication that may not be readily appreciated by clinicians who routinely perform femoral vascular cannulation. After all evidence of ongoing infection had disappeared, both cases ultimately were treated with total hip arthroplasty. Both patients have improved function and pain at 2.5 and 5 years of follow-up. Given the frequency with which femoral intravascular catheters are used in numerous procedures, methods of avoiding infection of the hip joint must be implemented. These 2 cases emphasize the potential risks of these procedures and show management with total hip arthroplasty.     

Septic arthritis of the hip caused by Yersinia enterocolitica: a case report

We report a case of bacteriologically documented hip infection caused by Yersinia enterocolitica. A 67-year-old male with a history of valvular disease was admitted for pain and motion range limitation in the left hip with a fever. No organisms were recovered by needle aspiration, but Yersinia enterocolitica grew in joint fluid obtained by surgical arthrotomy. Investigations of the gastrointestinal tract were normal, and there was no evidence of endocarditis. After 6 weeks of appropriate antibiotic therapy and immobilization with transtibial traction, the clinical and laboratory test abnormalities improved. However, the patient died from an intercurrent condition. Y. enterocolitica, a well-known cause of reactive arthritis, can cause septic arthritis.     

Septic arthritis of the hip in patients with femoral head osteonecrosis

Septic hip is rare in patients with femoral head osteonecrosis (FHON) and has been known to occur in those who are immune compromised. Thus, surgeons do not concern about the superimposed septic hip in immunocompetent patients. We report five patients who had FHON and concomitant septic arthritis of the hip. No patients were immune compromised. All patients had an elevation of ESR and CRP. Two patients had an otherwise unexplained fever preoperatively. Two patients had had a remote septic focus. When a patient with FHON has an unexplained elevation of ESR and CRP, concomitant septic arthritis of the hip should be suspected even though the patient is not immune compromised.     

Septic arthritis of the manubriosternal joint

Pyarthrosis of the manubriosternal joint is exceedingly rare. Its rarity defies an early diagnosis, and other causes of chest pain would normally be ruled out first. We describe a patient with a short history of chest pain, pyrexia, and raised inflammatory markers. A destroyed manubriosternal joint with a large abscess was found during surgical exploration. This case illustrates an unusually rapid development of septic arthritis involving a fibrocartilaginous joint in an otherwise healthy young man. Nine other cases have been described in the literature and are reviewed. Early diagnosis followed by adequate surgical drainage and antibiotic therapy led to a good outcome.     

Septic arthritis of the acromioclavicular joint

The acromioclavicular joint is rarely the site of septic arthritis. We conducted a retrospective review at our rheumatology department, which identified five cases within the last 6 years. All five patients were males, and their mean age was 63 years. Risk factors were consistently identified and included intravenous substance abuse, prior joint disease, a recent history of intraarticular injections, and a remote history of surgery. Joint aspiration was performed in all five patients and provided the organism in two patients. Blood cultures recovered Staphylococcus aureus in three patients, a coagulase-negative Staphylococcus in one patient, and no organism in one patient. Ultrasonography and/or magnetic resonance imaging established the early diagnosis in four patients and ruled out concomitant involvement of the glenohumeral joint. Only about 20 cases of septic arthritis of the acromioclavicular joint have been reported to date. This rare infection must be diagnosed rapidly to prevent joint destruction. The treatment is that usually recommended for septic arthritis.     

Septic arthritis of the acromioclavicular joint

A patient with isolated pyogenous arthritis of the acromioclavicular joint (A-C joint) caused by Streptococcus viridans is described. The patient had no underlying disease. Minor trauma preceded shortly the development of the septic process. The patient was treated successfully with surgical drainage and antibiotics. To our knowledge this is the first case report of septic arthritis of the A-C joint caused by Streptococcus viridans. The A-C joint is rarely involved in septic processes. Even conditions such as intravenous drug abuse [3, 6] and renal dialysis [4, 7] which tend to infect unusual joints [5] have only rarely been described in association with A-C septic arthritis.     

Septic arthritis of the acromioclavicular joint

Summary A patient with isolated pyogenous arthritis of the acromioclavicular joint (A-C joint) caused by Streptococcus viridans is described. The patient had no underlying disease. Minor trauma preceded shortly the development of the septic process. The patient was treated successfully with surgical drainage and antibiotics. To our knowledge this is the first case report of septic arthritis of the A-C joint caused by Streptococcus viridans. The A-C joint is rarely involved in septic processes. Even conditions such as intravenous drug abuse [3, 6] and renal dialysis [4, 7] which tend to infect unusual joints [5] have only rarely been described in association with A-C septic arthritis.

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Zusammenfassung Ein Patient mit einer isolierten pyogenen Arthritis des Acromioclavicular-Gelenks, hervorgerufen durch Streptococcus viridans, wind beschrieben. Der Patient hatte keine zugrunde liegende Krankheit. Ein leichtes Trauma ging den Entwicklung des septischen Prozesses voraus. Der Patient wurde erfolgreich mit chirurgischer Drainage und Antibiotica behandelt. Nach unserem Wissen ist dies der erste Bericht über septische Arthritis des Acromioclavicular-Gelenks, hervorgerufen durch Streptococcus viridans. Das Acromioclavicular-Gelenk ist selten von septischen Prozessen betroffen. Sogar Bedingungen wie intravenöser Drogenmißbrauch und Nierendialyse, die zur Infektion ungewöhnlicher Gelenke führen können, wurden nun selten in Verbindung mit septischen Arthritis des Acromioclavicular-Gelenks beschrieben.

     

Septic arthritis of the hip in a hemophiliac. Report of a case

Septic arthritis of the hip occurred in a 32-year-old hemophiliac with circulating Factor VIII antibodies. The clinical presentation suggested a soft tissue hematoma, but failure of early resolution with immobilization and Factor VIII replacement led to a correct diagnosis. A non-invasive method of management is essential if antibodies to Factor VIII are present. Compression and Plaster of Paris immobilization of the joint with adequate antibiotic therapy allows resolution of the infection and return to normal function. To avoid the serious complication of septic arthritis in hemophilia, expeditious treatment of all foci of infection is a necessity.     

Septic arthritis of the hip in infancy: long-term follow-up

At a mean 15-year follow-up, the authors evaluated five hips in five patients who had complete destruction of the femoral head and neck from septic arthritis when they were 3 months old. All patients were treated with a trochanteric arthroplasty in combination with a proximal femoral varus osteotomy at a mean age of 30 months in an attempt to salvage a femoral-pelvic articulation. Results suggest this treatment can provide a stable, painless, and functional hip, with an improved gait and less leg-length discrepancy than predicted if no reconstructive effort were attempted.     

Septic arthritis of the hip secondary to rat bite fever: a case report

Rat bite fever is a rare infection typically caused by Streptobacillus moniliformis. The mode of transmission is most commonly through a bite or scratch from an infected rat. This disease is characterized by polyarthritis, fever, and a delayed onset erythematous maculopapular rash of the extremities. The authors report a case of rat bite fever, which led to septic arthritis of the hip. To the authors' knowledge, the complication of hip sepsis requiring an arthrotomy has not been reported in the literature. The orthopaedist should be aware of not only Streptobacillus moniliformis, but also of other zoonotic organisms, which potentially can cause septic arthritis and warrant treatment with specific antibiotics.     

Septic arthritis of the hip with Propionibacterium avidum bacteremia after intraarticular treatment for hip osteoarthritis

Propionibacterium avidum is a Gram-positive, nonsporulating, facultative anaerobe that has a low level of virulence and is rarely pathogenic. This ubiquitous inhabitant of the sebaceous glands and hair follicles can cause acne vulgaris. Very rarely, P. avidum causes systemic infections after invasive procedures, most notably in immunocompromised patients. Two cases of sacroiliitis due to P. avidum have been reported. We report a case of P. avidum arthritis of the hip with severe sepsis that developed in a 78-year-old woman after intraarticular glucocorticoid treatment for hip osteoarthritis. We are unaware of previous reports of P. avidum hip arthritis.