Infection versus ALVAL: acute presentation with abdominal pain

Abstract

A 52-year-old man underwent bilateral articular surface replacement (ASR) DePuy in June 2006. Following a right femoral neck fracture 4 days postoperatively, he underwent revision to a cemented C-stem DePuy, a taper sleeve adaptor and a 47 mm diameter cobalt chromium femoral head. The patient recovered well with satisfactory 5-year follow-up. In September 2011 the patient presented to the accident and emergency department with a 5-day history of feeling unwell with right lower quadrant pain. Examination of the right hip was unremarkable apart from painful adduction. Blood tests showed raised inflammatory markers and white cell count. MRI scan showed a right iliopsoas collection which appeared to communicate with the hip joint. The patient underwent a direct exchange of the right hip prosthesis. The intraoperative clinical picture was suggestive of atypical lymphocytic vasculitis and associated lesions. The patient recovered well and was discharged home. At his last clinic visit he was well and pain free.

Figure 1

Postoperative radiograph June 2006.

Figure 2

Right psoas collection.

Figure 3

A white creamy collection visualised within the hip joint intraoperatively.

Figure 4

Black staining of the trunion.

Figure 5

Macroscopic wear of the taper.

Figure 6

Radiograph of the hip revised to a Duraloc DePuy uncemented cup with a ceramic liner and a short stem Exeter Stryker cemented femoral stem with a 32 mm ceramic head.