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A Rare Case of Extremely Severe Heterotopic Ossification after Primary Total Hip Arthroplasty due to Persistent Mild
Yutaka Kinoshita1, Shunji Nakano1, Shinji Yoshioka1
1Department of Orthopedics, Tokushima Municipal Hospital, Tokushima, Japan.
Abstract:
Periprosthetic joint infection (PJI) caused by coagulase-negative staphylococci (CNS) can be a mild, persisting infection. Although heterotopic ossification (HO) is common following total hip arthroplasty (THA), the etiology of severe HO remains unclear. Herein, we describe a rare case of extremely severe HO after a PJI associated with a Staphylococcus caprae infection in a 78-year-old male patient. The patient had poorly controlled diabetes mellitus with no diabetic complications. The patient had no previous history of hip surgery, hip injury, or systemic bacterial infection. Immediately after the initial THA, he developed intermittent low-grade fever (37°C), which persisted for 3 months; consequently, he also reported mild hip pain during walking. He experienced a gradual decrease in hip range of motion within 5 years after the surgery, with progressive gait impairment. Two revision surgeries were required for the successful treatment of this difficult case. The patient's hip function improved, and the PJI was controlled following the second revision surgery. Based on the clinical course, CNS-caused PJI may lead to severe HO. This possibility warrants verification from an accumulated number of cases.
Insights
Periprosthetic joint infection (PJI) caused by coagulase-negative staphylococci (CNS) may lead to severe heterotopic ossification (HO). This case report highlights a rare instance of severe HO following Staphylococcus caprae PJI after total hip arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Case Reports
Background:
- Periprosthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA).
- Coagulase-negative staphylococci (CNS) are common causes of PJI, often presenting as chronic, low-grade infections.
- Heterotopic ossification (HO) is a known complication of THA, but severe forms are less understood.
Observation:
- A 78-year-old male with poorly controlled diabetes developed PJI after primary THA.
- The PJI was caused by *Staphylococcus caprae*, a type of CNS.
- The patient experienced persistent low-grade fever, hip pain, decreased range of motion, and gait impairment over five years.
Findings:
- The patient developed extremely severe heterotopic ossification (HO) secondary to the CNS PJI.
- Two revision surgeries were necessary to manage the infection and address the severe HO.
- Successful treatment led to improved hip function and control of the PJI.
Implications:
- This case suggests a potential link between CNS-caused PJI and the development of severe HO.
- Further research with larger case series is needed to confirm this association.
- Clinicians should consider the possibility of severe HO in patients with chronic PJI.
