A rare case of acetabulum osteomyelitis mimicking bone sarcoma

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Radiology

Background:

• A 57-year-old male presented with a 3-month history of right hip joint pain.
• Initial imaging (MRI, bone scintigraphy) suggested a bone sarcoma in the acetabulum.
• Initial biopsy revealed chronic fibrous osteomyelitis with Staphylococcus aureus.

Purpose of the Study:

• To investigate a suspected bone sarcoma in the right acetabulum.
• To accurately diagnose and manage a challenging hip joint infection.
• To evaluate the efficacy of surgical debridement and antibiotic therapy for chronic osteomyelitis.

Main Methods:

• Computer tomography-guided biopsy followed by open biopsy and joint puncture.
• Microbiologic and histopathologic examination of tissue samples.
• Septic femoral head and neck resection with debridement, necrosectomy, and lavage.
• Implantation of a gentamicin and vancomycin-impregnated cement spacer.
• Postoperative systemic and oral antibiotic administration.
• Delayed prosthesis implantation after infection control.

Main Results:

• Repeat biopsies identified Staphylococcus aureus and Staphylococcus epidermidis.
• Surgical intervention and antibiotic therapy successfully eradicated the infection.
• The patient experienced an uneventful postoperative recovery.
• Inflammatory markers (WBC, CRP) normalized pre-prosthesis implantation.
• Histologic and microbiologic examination confirmed no persistent infection.
• One-year follow-up showed no signs of infection or local complaints.

Conclusions:

• Chronic osteomyelitis can mimic bone sarcoma on initial imaging.
• Aggressive surgical management combined with targeted antibiotic therapy is effective.
• This approach allows for successful joint reconstruction and patient recovery.