Six-stage revision surgery of a triple periprosthetic joint infection due to a delayed diagnosis of a bilateral psoas abscess: a case report

Abstract

Case: We present a case of a 70-year-old woman with simultaneous periprosthetic joint infection (PJI) of both hips and left knee due to a bilateral psoas abscess. The patient underwent debridement and implants removal with the consequent reimplantation in a sequential six-stage revision surgery. At four years of follow-up and in spite of the patient's comorbidities and current PJI presentation, she maintains full activities of daily living without restrictions.

Conclusion: Accurate and early diagnosis of a psoas abscess is crucial. This case report provides experience of a complex scenario, the decision-making involved and the outcomes of an underdiagnosed complication.

Keywords: Periprosthetic joint infection; Psoas abscess; Simultaneous periprosthetic joint infection; Total hip arthroplasty; Total knee arthroplasty.

Figure 1

Clinical images showing the patient in the left lateral decubitus position evidencing a sinus tract, erythema and purulent fluid in the right hip (a). Image of the left hip with a sinus tract at the distal end of the previous incision (b). Image of the left knee showing the sinus tract (c).

Figure 2

Anteroposterior pelvic radiograph showing right total hip arthroplasty (THA) dislocation, and cup loosening and bone deficiency of both THAs

Figure 3

Anteroposterior (a) and lateral (b) view radiographs showing the left total knee arthroplasty (TKA) at the onset of symptoms without evident signs of loosening

Figure 4

Anteroposterior (a–c) and lateral (d) postoperative views after first-stage revision surgery showing the tobramycin-impregnated cement spacer implanted

Figure 5

Anteroposterior (a) view of the right hip revision surgery, showing reconstruction with a trabecular metal acetabular revision shell and a cemented polished femoral stem with IBG technique at one year of follow-up. Anteroposterior (b) view of the left hip revision surgery, showing reconstruction with a trabecular metal acetabular revision shell and a cementless distally fixed modular fluted stem at one year of follow-up.

Figure 6

Anteroposterior (a) and lateral (b) views of the left knee revision surgery, showing reconstruction after tibial tubercle osteotomy (TTO) with long cemented stems in both femoral and tibial components and a constrained total stabilised prosthesis as a consequence of soft tissue instability at one year of follow-up.