Cellulitis after hip surgery: long-term follow-up of seven cases

Cellulitis of the buttock after hip surgery is rarely reported, but raises concern about possible infection of the implant. In view of this we have investigated the frequency of previous hip surgery in patients with cellulitis of the hip and/or buttock and assessed for any predisposing factors. A review was made of the case notes of all patients admitted to our department with infectious cellulitis of the hip and/or buttock between 1981 and 1995. Seven of nine patients previously had had implantation of a hip prosthesis. The interval between skin infection and surgery was 7-9 weeks in two patients and 55-520 weeks in five. No infection of the implant was evident. The assumed portals of entry were gluteal fold intertrigo, tinea pedis, psoriatic plaque and a carbuncle of the buttock. The infection was successfully treated by intravenous antibiotics and, after a follow-up of a mean 64 months, no recurrence of cellulitis has been observed and only one aseptic loosening has occurred. Infectious cellulitis of the hip or buttock following hip surgery can occur secondary to impaired lymphatic drainage, a few weeks up to several years after surgery, without there being any infection of the orthopaedic implant.