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Eradication of Salmonella enteritidis periprosthetic hip infection using a custom-made articulating spacer: A case
Kwong Weng Loh, Khairul Anwar Ayob, Azlina Amir Abbas1
1National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia. azabbas@um.edu.my.
Abstract:
Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA), commonly managed through a two-stage revision which can lead to significant morbidity. In this article, we present a rare case of Salmonella enteritidis PJI, initially presenting as prosthetic hip dislocation. Preoperative hip aspiration utilizing blood culture bottles enabled early identification of the organism and guided targeted antimicrobial therapy. The patient underwent revision THA using a well-fixed custom-made articulating spacer (CUMARS) construct, with targeted antibiotic-loaded bone cement. One-year follow-up demonstrated successful eradication of the infection, stable implant fixation, and good functional outcomes. In conclusion, this case underscores the importance of diagnostic hip aspiration and highlights the potential of the CUMARS technique as an effective and durable solution for managing rare PJIs caused by atypical organisms such as Salmonella enteritidis.
Insights
This case study highlights a rare Salmonella enteritidis periprosthetic joint infection (PJI) after hip replacement. Early diagnosis via hip aspiration and treatment with a custom articulating spacer (CUMARS) led to successful infection eradication.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Periprosthetic joint infection (PJI) is a significant complication after total hip arthroplasty (THA), often requiring complex management.
- Two-stage revision surgery for THA PJI can result in substantial patient morbidity.
- Atypical organisms like Salmonella enteritidis present unique diagnostic and therapeutic challenges in PJI cases.
Purpose of the Study:
- To report a rare case of Salmonella enteritidis PJI following THA.
- To emphasize the utility of preoperative hip aspiration for early pathogen identification.
- To evaluate the efficacy of a custom-made articulating spacer (CUMARS) with antibiotic-loaded bone cement for treating rare PJIs.
Main Methods:
- Diagnostic hip aspiration using blood culture bottles for microbiological analysis.
- Revision THA employing a custom-made articulating spacer (CUMARS) construct.
- Application of targeted antibiotic-loaded bone cement during revision surgery.
Main Results:
- Early identification of Salmonella enteritidis through hip aspiration facilitated targeted antimicrobial therapy.
- The CUMARS construct demonstrated stable implant fixation one year post-revision.
- Successful eradication of the PJI was achieved, with good functional outcomes reported.
Conclusions:
- Preoperative hip aspiration is crucial for diagnosing rare PJIs, guiding effective treatment.
- The CUMARS technique offers a potentially effective and durable solution for managing complex PJIs caused by unusual pathogens.
- This case highlights Salmonella enteritidis as a rare but treatable cause of PJI after THA.
