Purulent Infection in a Native Adult Hip with Healed Perthe’s Disease: A Rare Presentation

Case Report

Austin J Orthopade & Rheumatol. 2019; 6(2): 1078.

Purulent Infection in a Native Adult Hip with Healed Perthe’s Disease: A Rare Presentation

Raval P* and Abbas A

Department of Orthopedics, Wishaw General Hospital, UK

*Corresponding author: Mr. Pradyumna Raval, Department of Orthopedics, Wishaw General Hospital, Scotland, UK

Received: September 23, 2019; Accepted: October 23, 2019; Published: October 30, 2019

Abstract

Septic arthritis of a joint is one of the few orthopedic emergencies wherein a prompt diagnosis and early intervention is warranted in order to prevent any further joint destruction. Septic arthritis of hip has a dramatic presentation in the pediatric population, but is relatively unheard of in adults. In the few adult patients who present with septic arthritis of native hip joint, an underlying comorbidity like rheumatoid arthritis or diabetes is frequently present. We present an extremely rare case of a purulent septic arthritis in a healthy individual with healed Perthes disease; which was successfully treated with open arthrotomy.

Keywords: Perthe’s disease; Hip; Purulent; Infection

Case Presentation

A 47-year-old gentleman, Heavy Goods Vehicle (HGV) driver by occupation, presented to our Emergency Department (ED) with a one day history of sudden onset left hip pain. There was no history of any antecedent trauma. This person was well built and had no comorbidities. He was diagnosed with Perthes disease of his left hip and underwent an osteotomy for the same as a child. Subsequent implant removal was performed, with him being absolutely asymptomatic till this particular presentation.

Initial blood investigations revealed a high C - reactive protein (CRP) value of 76 mg/L and an elevated WBC count with neutrophilia. Radiographic investigations were inconclusive (Figure 1). In the next 24 hours the CRP value almost doubled to 146 mg/L and WBC continued to rise. An urgent ultrasound scan revealed a collection around the left hip (Figure 2). An arthrotomy was performed as an emergency using the anterolateral approach. Frank purulent material was obtained from the left hip which was sent for microbiological evaluation.