Should We Routinely Exclude Retroperitoneal Abscess in Cases of Hip Periprosthetic Joint Infections?

Abstract

Hip periprosthetic joint infections (PJIs) with concomitant retroperitoneal abscesses may not be common clinical situations but they can be easily misdiagnosed affecting the effectiveness of infection control and eradication interventions. We present the case of a 75-year-old female patient with a late hip PJI complicated with iliopsoas abscess that was barely discovered intraoperatively. Literature review supports our recommendation of a high index of suspicion in cases of hip PJI and even routinely imaging examination of pelvis and abdomen for retroperitoneal involvement exclusion.

Keywords: 2-stage hip arthroplasty revision; iliopsoas abscess; periprosthetic joint infection; retroperitoneal abscess; total hip arthroplasty.

Figure 1. Pro-operative X-ray.

Pro-operative X-ray of pelvis and right hip total arthroplasty reveals hip space effusion (red arrows) but there is no clear sign of iliopsoas abscess.

Figure 2. Postoperative CT scan.

Transverse (2a) and coronal (2b) views of postoperative CT scan showing various empty spaces in retroperitoneum and hip region created by abscesses drainage.

Figure 3. Postoperative X-rays.

X-ray after first-stage surgical debridement and antibiotic cement spacers application (3a) and after second-stage reimplantation with constrained total hip arthroplasty (3b).