Septic coxitis after an intramuscular injection in a young adult treated by two-steps total hip arthroplasty: a case report

Abstract

Introduction: Septic arthritis of the hip is a rare condition in adults and its treatment depends on symptoms duration: early onset of infection can be treated with open or arthroscopic debridement, while more aggressive surgery is required when articular damage takes place such as articular resection or total hip replacement (THA). Presentation of case: We report a case of a 30 year old man affect by septic arthritis of the hip after an intramuscular injection of diclofenac successfully treated with a two-steps THA. Discussion: In literature there aren’t many cases of septic arthritis of the hip developed after intramuscular injections. Early onset of infection can be treated with an accurate articular debridement, while chronic conditions are traditionally treated by resection arthroplasty. However resection arhtroplasty gives to the patients a significant leg length discrepancy and, especially in young adults, a two-steps surgery with the implant of THA can lead to good results, as reported in recent case series published. Conclusion: In our experience two-stage total hip arthroplasty proved to be a reliable solution for septic arthritis of the hip and may be used in patient with severe joint damage. Furthermore we want underline importance of correct anamnesis to make quickly the right diagnosis and provide the right treatment of septic arthritis of the hip also in difficult clinical cases. Highlights:

Three Episodes of Presumed Culture-Negative Septic Arthritis Following Intramuscular Antipsychotic Injections

“…In addition to this, a single case series describes 9.7% of children with septic arthritis having had an intramuscular injection into the gluteal muscles 22 . Further supporting a relation between intramuscular injection and septic arthritis, skin commensals were cultured in 2 of the reported cases 8,11 . Three presentations 8,10,11 occurred in a joint adjacent to the injection site.…”

“…Further supporting a relation between intramuscular injection and septic arthritis, skin commensals were cultured in 2 of the reported cases 8,11 . Three presentations 8,10,11 occurred in a joint adjacent to the injection site. In the current study, the presumed septic arthritis of the right hip followed right gluteal muscle injections, and the presumed septic arthritis of the left hip followed left gluteal muscle injection (Table IV).…”

“…Despite culture-negative septic arthritis being well recognized in the literature, there are only 5 cases of septic arthritis after intramuscular injection reported [7][8][9][10][11] . In addition to this, a single case series describes 9.7% of children with septic arthritis having had an intramuscular injection into the gluteal muscles 22 .…”

“…Risk factors include immunodeficiencies, smoking, male sex, specific ethnicities, low socioeconomic status, rheumatologic disease, and trauma [4][5][6] . There have been only sporadic reports of septic arthritis after intramuscular injections [7][8][9][10][11] .…”