Related Experiment Videos
Positive leukocyte and negative bone scintigraphy in extensive arthroplasty infection
Tack Shin Lee1, Robert Elliott, Kevin Allman
1Department of Orthorpedic Surgery & nuclear Medicine, Concord Hospital, Sydney, Australia. Australia.hansv@nmrf.org.au
Abstract:
An 85-year-old male resident of a nursing home presented after a fall with a painful left hip, confusion, and fever. He had multiple medical problems including severe vascular disease and poor vision as a result of macular degeneration. An Austin Moore left hip prosthesis had been inserted for a fractured femoral neck several years before. A septic workup showed a raised leukocyte count but no other focal abnormality. Plain radiography showed a periprosthetic fracture of the left hip. Blood cultures grew beta-hemolytic group A Streptococcus sensitive to penicillin. Bone scintigraphy was thought to be consistent with loosening of the prosthesis without evidence of a recent fracture. Tc-99m leukocyte scintigraphy was markedly abnormal, with extensive soft-tissue uptake suggestive of a large periprosthetic infective collection. This was confirmed at surgery with drainage of 200 mL pus from the left hip, and deep and superficial soft tissues of the thigh. The trochanteric fracture was well granulated and thought to be of long standing. The prosthesis was removed and the patient was treated with appropriate antibiotics with good effect.
Insights
An elderly male with a hip prosthesis developed a periprosthetic infection and fracture. Prompt diagnosis and surgical intervention with antibiotics led to a successful recovery.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Geriatric Medicine
Background:
- An 85-year-old male with multiple comorbidities, including vascular disease and macular degeneration, presented with symptoms suggestive of hip pathology.
- The patient had a history of an Austin Moore left hip prosthesis insertion for a prior femoral neck fracture.
Observation:
- The patient presented with a painful left hip, confusion, and fever following a fall.
- Radiography revealed a periprosthetic fracture, while blood cultures identified beta-hemolytic group A Streptococcus sensitive to penicillin.
- Tc-99m leukocyte scintigraphy indicated a significant periprosthetic infective collection.
Findings:
- Surgical exploration confirmed a large periprosthetic infection with 200 mL of pus drained from the left hip and thigh.
- The trochanteric fracture was noted to be chronic and well-granulated.
- The hip prosthesis was removed, and the patient received effective antibiotic treatment.
Implications:
- This case highlights the importance of considering periprosthetic joint infection in elderly patients with hip prostheses presenting with fever and pain after a fall.
- Advanced imaging like Tc-99m leukocyte scintigraphy is crucial for diagnosing deep-seated infections around prosthetic implants.
- Multidisciplinary management involving orthopedic surgery, infectious diseases, and judicious antibiotic therapy is essential for favorable outcomes in such complex cases.