PERIPROSTHETIC HIP INFECTION: DIAGNOSIS, SAMPLE COLLECTION, AND THERAPEUTIC DECISION

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0846

Abstract

Periprosthetic hip infection is one of the most challenging complications after total hip arthroplasty and requires rigorous integration of clinical, serum, synovial, microbiological, and intraoperative findings to support rational therapeutic decision-making. We present an academic prototype case of a 69-year-old woman who had undergone left total hip arthroplasty three years earlier for primary osteoarthritis and presented with progressive groin pain and functional deterioration over four months, without a sinus tract. Serum testing showed a C-reactive protein level of 38 mg/L and an erythrocyte sedimentation rate of 72 mm/h. Hip aspiration, performed after a two-week antibiotic-free interval, showed 18,600 leukocytes/µL, 89% polymorphonuclear cells, positive leukocyte esterase, and culture growth of methicillin-susceptible Staphylococcus epidermidis. Because of the chronic course, radiographic loosening, and likely mature biofilm, a two-stage revision strategy was selected. Five deep intraoperative samples were obtained from different anatomical sites; four of five cultures and histopathology supported infection. After prosthesis removal, placement of an antibiotic-loaded articulating spacer, and targeted antimicrobial therapy, delayed reimplantation was performed with a favorable outcome. At 12 months, the patient remained free of clinical or radiographic recurrence and had satisfactory functional recovery. This prototype case highlights the value of multimodal diagnosis, standardized specimen collection, and individualized surgical planning.

Keywords: periprosthetic joint infection; hip; total hip arthroplasty; diagnosis; cultures; revision arthroplasty.