Bilateral Lower-Extremity Edema Caused by Iliopsoas Bursal Distention after Hip Arthroplasty

Abstract

Lower-extremity edema is encountered by internists, nephrologists, vascular specialists, and many others. We report a case of an elderly woman who presented with a painful, swollen left leg. Without a clear diagnosis, she had been taking diuretics for the past 8 years for swelling in both legs. After extensive investigation, we found that her lower-extremity edema was due to bilateral iliopsoas bursal distention secondary to degeneration of her hip prostheses. Chronic breakdown of the polyethylene component of the hip prostheses had led to a communication between the artificial joints and the iliopsoas bursae. With the aid of ultrasonographic guidance, she underwent drainage, followed by clinical and radiographic improvement. Although case reports have described leg swelling arising from extravascular compression by enlarged iliopsoas bursae, we think that this is the first case of clinically significant bilateral lower-extremity edema arising from that cause. More important than the novelty is the inappropriate use of diuretics to treat lower-extremity edema without first establishing a diagnosis.

Keywords: Arthroplasty, replacement, hip/adverse effects; bursa, synovial/pathology; edema/etiology/physiopathology; hip prosthesis/adverse effects; leg/blood supply; psoas muscles/radiography; risk factors; treatment outcome; vascular diseases/etiology.

Fig. 1

Computed tomographic venogram (axial view) shows bilateral iliopsoas bursal distention. The left (L) iliopsoas bursa is 8.1 × 5.3 × 3.8 cm (craniocaudal × anteroposterior × width); the right (R) bursa is 3.4 × 1.7 cm (anteroposterior × width).