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Case Reports
. 2024 Nov;14(11):103-109.
doi: 10.13107/jocr.2024.v14.i11.4930.

Two Stage Revision Total Hip Arthroplasty for Enterobacter Induced Periprosthetic Joint Infection in an Elderly Female: A Case Report

Pervez Ahsan  1 , Md Mostafizur Rahaman  1 , Israt Jahan  1 , Nusrat Sharmin Asma  1 , Md Shah Paran  1 , Syed E Shaude  2
Affiliations
Case Reports

Two Stage Revision Total Hip Arthroplasty for Enterobacter Induced Periprosthetic Joint Infection in an Elderly Female: A Case Report

Pervez Ahsan et al. J Orthop Case Rep. 2024 Nov.

Abstract

Introduction: Periprosthetic joint infections (PJIs) present a growing challenging complication in joint surgeries, with increasing incidence and significant clinical implications. The complexity of PJIs lies in its interaction between microbes and the host immune response. While Enterobacter infections are rare in PJIs, they pose severe risks due to their resistance and virulence. PJIs burden healthcare systems and profoundly impact patients, especially those unable to access necessary treatments due to socioeconomic limitations, like our patient who had suffered from excruciating pain and immobility for 6 years. To the best of our knowledge, this is the first case report of its kind.

Case report: A 55-year-old woman presented to us with severe right hip pain for 10 years and recurrent swelling over the incisional site with discharging sinus and intermittent fever for 6 years. She underwent through a unipolar hemiarthroplasty due to right-sided femoral neck fracture 10 years back. Severe pain and recurrent infections led to functional limitations and deteriorating quality of life. History, clinical examination, serological, and radiological investigations confirmed the diagnosis. Two-stage revision total hip arthroplasty was performed. Regular follow-ups were done after the surgical procedure. After revision, she experienced no pain or recurrence of infection. Her Harris Hip Scores were 9 and 80 before and after two-stage revision surgery, indicating a favorable outcome.

Conclusion: This case highlights the challenges of PJI management, especially in patients from poor socioeconomic condition. Despite obstacles, intervention with two-stage revision arthroplasty resulted in significant clinical and psychological improvement. Enhanced healthcare accessibility and tailored interventions are crucial for optimizing PJI outcomes.

Keywords: Harris Hip Score; Periprosthetic joint infection; osteoporosis; revision total hip replacement; unipolar hemiarthroplasty.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
X-ray pelvis showing right-sided prosthesis on anterior-posterior view.
Figure 2
Figure 2
(a) Removal of the prosthesis (b) removed prosthesis (c) operative view after removal.
Figure 3
Figure 3
Post-operative X-ray pelvis showing cement spacer after removal of the prosthesis on anterior-posterior view.
Figure 4
Figure 4
Placement of acetabular cup.
Figure 5
Figure 5
Fibulectomy procedure.
Figure 6
Figure 6
Wiring of the grafted bone.
Figure 7
Figure 7
Placement of the femoral stem with bone graft.
Figure 8
Figure 8
X-ray pelvis at 1st post-operative day (a) anterior-posterior view (b) lateral view.
Figure 9
Figure 9
Post-operative X-ray pelvis after 18 months (a) anterior-posterior view (b) lateral view.
See this image and copyright information in PMC

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