Case for diagnosis. Suppurative nodule or something deeper?

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Radiology

Background:

• Total hip arthroplasty is a common procedure for hip joint issues.
• Prosthetic joint infections are a known but infrequent complication.
• Late-onset infections can occur years after initial surgery.

Observation:

• A 62-year-old male presented with a large, infiltrated plaque on his left thigh.
• The lesion evolved over three months without systemic symptoms or elevated inflammatory markers.
• Computed tomography revealed a 12 cm linear extension to the proximal femur.

Findings:

• The imaging findings were suspicious for a deep-seated infection related to the prior hip arthroplasty.
• Despite the long interval since surgery, a prosthesis joint infection was suspected.
• Absence of systemic inflammatory markers can sometimes mask late prosthetic joint infections.

Implications:

• This case underscores the need for vigilance regarding late-onset prosthesis joint infections, irrespective of the time elapsed since arthroplasty.
• Early diagnosis and management are crucial for favorable outcomes in prosthetic joint infections.
• Radiological evaluation is essential for assessing the extent of infection and its relation to the prosthesis.