Avascular necrosis of the femoral head in combination with septic arthritis of the hip joint

Abstract

BACKGROUND: The combined course of avascular necrosis of the femoral head and septic arthritis of the hip joint is extremely rare and not always timely diagnosed. Analysis of specialized foreign literature revealed only single descriptions of clinical cases of combined lesions of the hip joint (avascular necrosis of the femoral head and septic arthritis). However, these studies do not describe the surgical treatment algorithms of patients. While analyzing the sources of domestic literature for the last 10 years, we did not encounter descriptions of such clinical cases.

CLINICAL CASE DESCRIPTION: A 38-year-old patient was diagnosed with avascular necrosis of the femoral head with concomitant septic arthritis of the hip joint. During the preoperative period, a diagnostic puncture of the hip joint with subsequent cytologic and microbiological examination of synovial fluid was performed. Growth of the Staphylococcus aureus strain was observed. Because primary hip arthroplasty was contraindicated and isolated conservative treatment of bacterial arthritis aggravated the course of avascular necrosis, the patient underwent two-stage surgical treatment. The first stage was femoral head resection with installation of a spherical cement spacer impregnated with antibiotics, and the second stage was total hip arthroplasty after the inflammatory process had subsided. The postoperative period of each surgical stage proceeded without complications. It was possible to achieve microorganism eradication; eliminate the chronic inflammatory process, which was confirmed clinically and laboratory; ensure the possibility of total hip arthroplasty; and restore the limb-bearing capacity, extent of motion in the joint, and quality of life of the patient.

CONCLUSION: The clinical observation confirms the need for detailed diagnosis in patients with an atypical course of avascular necrosis of the femoral head and demonstrates a successful treatment option in such cases.

Keywords

avascular necrosis of the femoral head / osteonecrosis / AVN of the hip / septic arthritis / spacer / revision hip replacement / case report

References

[1] Rackwitz L, Eden L, Reppenhagen S, et al. Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head. Stem Cell Res Ther. 2012;3(1):7. doi: 10.1186/scrt98

[2] Rackwitz L., Eden L., Reppenhagen S., et al. Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head // Stem Cell Res Ther. 2012. Vol. 3, № 1. Р. 7. doi: 10.1186/scrt98

[3] Mustafin RN, Khusnutdinova EK. Avascular necrosis of the femoral head. Pacific Medical Journal. 2017;(1):27–35. doi: 10.17238/PmJ1609-1175.2017.1.27-35

[4] Мустафин Р.Н., Хуснутдинова Э.К. Аваскулярный некроз головки бедренной кости // Тихоокеанский медицинский журнал. 2017. № 1. С. 27–35. doi: 10.17238/PmJ1609-1175.2017.1.27-35

[5] Torgashin AN, Rodionova SS. Osteonecrosis in Patients Recovering from COVID-19: Mechanisms, Diagnosis, and Treatment at Early-Stage Disease (Review). Traumatology and Orthopedics of Russia. 2022;28(1):128–137. doi: 10.17816/2311-2905-1707

[6] Торгашин А.Н., Родионова С.С. Остеонекроз у пациентов, перенёсших COVID-19: механизмы развития, диагностика, лечение на ранних стадиях (обзор литературы) // Травматология и ортопедия России. 2022. Т. 28, №1. C. 128–137. doi: 10.17816/2311-2905-1707

[7] Grieser T. Atraumatische und aseptische Osteonekrose großer Gelenke. Radiologe. 2019;59(7):647–662. doi: 10.1007/s00117-019-0560-3

[8] Grieser T. Atraumatische und aseptische Osteonekrose großer Gelenke // Radiologe. 2019. Vol. 59, № 7. Р. 647–662. doi: 10.1007/s00117-019-0560-3

[9] Ardakani MV, Parviz S, Ghadimi E, et al. Concomitant septic arthritis of the hip joint and femoral head avascular necrosis in patients with recent COVID-19 infection: a cautionary report. J Orthop Surg Res. 2022;17(1):302. doi: 10.1186/s13018-022-03192-4

[10] Ardakani M.V., Parviz S., Ghadimi E., et al. Concomitant septic arthritis of the hip joint and femoral head avascular necrosis in patients with recent COVID-19 infection: a cautionary report // J Orthop Surg Res. 2022. Vol. 17, № 1. Р. 302. doi: 10.1186/s13018-022-03192-4

[11] Agarwala SR, Vijayvargiya M, Pandey P. Avascular necrosis as a part of ‘long COVID-19’. BMJ Case Rep. 2021;14(7):e242101. doi: 10.1136/bcr-2021-242101

[12] Agarwala S.R., Vijayvargiya M., Pandey P. Avascular necrosis as a part of ‘long COVID-19’ // BMJ Case Rep. 2021. Vol. 14, № 7. Р. e242101. doi: 10.1136/bcr-2021-242101

[13] Torgashin AN, Rodionova SS, Shumsky AA, et al. Treatment of aseptic necrosis of the femoral head. Clinical guidelines. Rheumatology Science and Practice. 2020;58(6):637–645. doi: 10.47360/1995-4484-2020-637-645

[14] Торгашин А.Н., Родионова С.С., Шумский А.А., и др. Лечение асептического некроза головки бедренной кости. Клинические рекомендации // Научно-практическая ревматология. 2020. Т. 58, № 6. С. 637–645. doi: 10.47360/1995-4484-2020-637-645

[15] Ilyinykh EV, Barskova VG, Lidov PI, Nasonov EL. Osteonecrosis. Part 1. Risk factors and pathogenesis. Modern rheumatology. 2013;(1):17–24. doi: 10.14412/1996-7012-2013-2362

[16] Ильиных Е.В., Барскова В.Г., Лидов П.И., Насонов Е.Л. Остеонекроз. Часть 1. Факторы риска и патогенез // Современная ревматология. 2013. № 1. С. 17–24. doi: 10.14412/1996-7012-2013-2362

[17] Belov BS, Muravyeva NV. Bacterial (Septic) Arthritis. Antibiotics and Chemotherapy. 2023;68(3–4):84–91. doi: 10.37489/0235-2990-2023-68-3-4-84-91

[18] Белов Б.С., Муравьёва Н.В. Бактериальный (септический) артрит // Антибиотики и химиотерапия. 2023. Т. 68, № 3–4. С. 84–91. doi: 10.37489/0235-2990-2023-68-3-4-84-91

[19] Bashkova IB, Madyanov IV. Alcohol abuse as an underestimated cause of non-traumatic osteonecrosis of the femoral head (description of clinical cases). Actamedica Eurasica [Internet]. 2021;(4):39–53 [cited 03.11.2022]. Available from: http://acta-medica-eurasica.ru/single/2021/4/5 doi: 10.47026/2413-4864-2021-4-39-53

[20] Башкова И.Б., Мадянов И.В. Злоупотребление алкоголем как недооценённая причина нетравматического остеонекроза головки бедренной кости (описание клинических случаев) // Actamedica Eurasica [Internet]. 2021. № 4. С. 39–53. Режим доступа: http://acta-medica-eurasica.ru/single/2021/4/5 Дата обращения: 03.11.2022. doi: 10.47026/2413-4864-2021-4-39-53

[21] Habermann ET, Friedenthal RB. Septic arthritis associated with avascular necrosis of the femoral head. Clin Orthop Relat Res. 1978;(134):325–31.

[22] Habermann E.T., Friedenthal R.B. Septic arthritis associated with avascular necrosis of the femoral head // Clin Orthop Relat Res. 1978. № 134. Р. 325–31.

[23] Zhiping Z, Xiangyu W, Changyao W, et al. Septic Hip Arthritis in Patients with Osteonecrosis of Femoral Head: Two Cases Report and Review of the Literature. 23 November 2020, Preprint (Version 1) available at Research Square. doi: 10.21203/rs.3.rs-112850/v1

[24] Zhiping Z., Xiangyu W., Changyao W., et al. Septic Hip Arthritis in Patients with Osteonecrosis of Femoral Head: Two Cases Report and Review of the Literature. 23 November 2020, Preprint (Version 1) available at Research Square. doi: 10.21203/rs.3.rs-112850/v1

[25] Tan TJ, Tan SC. Concomitant early avascular necrosis of the femoral head and acute bacterial arthritis by enteric Gram-negative bacilli in four oncologic patients. Singapore Med J. 2013;54(5):e108–12. doi: 10.11622/smedj.2013065

[26] Tan T.J., Tan S.C. Concomitant early avascular necrosis of the femoral head and acute bacterial arthritis by enteric Gram-negative bacilli in four oncologic patients // Singapore Med J. 2013. Vol. 54, № 5. Р. e108–12. doi: 10.11622/smedj.2013065

[27] Hassan AAA, Khalifa AA. Femoral head avascular necrosis in COVID-19 survivors: a systematic review. Rheumatol Int. 2023;43(9):1583–1595. doi: 10.1007/s00296-023-05373-8

[28] Hassan A.A.A., Khalifa A.A. Femoral head avascular necrosis in COVID-19 survivors: a systematic review // Rheumatol Int. 2023. Vol. 43, № 9. Р. 1583–1595. doi: 10.1007/s00296-023-05373-8

[29] Zhang S, Wang C, Shi L, Xue Q. Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19 — Experience and Lessons from the SARS Epidemic. Drug Des Devel Ther. 2021;15:983–995. doi: 10.2147/DDDT.S298691

[30] Zhang S., Wang C., Shi L., Xue Q. Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19 — Experience and Lessons from the SARS Epidemic // Drug Des Devel Ther. 2021. Vol. 15. Р. 983–995. doi: 10.2147/DDDT.S298691

[31] Murab S, Hawk T, Snyder A, et al. Tissue Engineering Strategies for Treating Avascular Necrosis of the Femoral Head. Bioengineering (Basel). 2021;8(12):200. doi: 10.3390/bioengineering8120200

[32] Murab S., Hawk T., Snyder A., et al. Tissue Engineering Strategies for Treating Avascular Necrosis of the Femoral Head // Bioengineering (Basel). 2021. Vol. 8, № 12. Р. 200. doi: 10.3390/bioengineering8120200

[33] Wojturska W, Nowakowski J, Pilch W, Biernikowicz M, Korkosz M. Reactive arthritis after vaccination against SARS-CoV-2: A case series and a mini-review. Hum Vaccin Immunother. 2023;19(1):2173912. doi: 10.1080/21645515.2023.2173912

[34] Wojturska W., Nowakowski J., Pilch W., Biernikowicz M., Korkosz M. Reactive arthritis after vaccination against SARS-CoV-2: A case series and a mini-review // Hum Vaccin Immunother. 2023. Vol. 19, № 1. Р. 2173912. doi: 10.1080/21645515.2023.2173912

[35] Panin MA, Zagorodniy NV, Boiko AV, Petrosyan AS. Total hip arthroplasty in the treatment of severe stages of osteonecrosis of the femoral head and osteoarthritis: results and complications. N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):345–353. doi: 10.17816/vto109955

[36] Панин М.А., Загородний Н.В., Бойко А.В., Петросян А.С. Тотальное эндопротезирование тазобедренного сустава в лечении поздних стадий остеонекроза головки бедренной кости и остеоартрита: результаты и осложнения // Вестник травматологии и ортопедии им Н.Н. Приорова. 2022. Т. 29, № 4. C. 345–353. doi: 10.17816/vto109955

[37] Tikhilov RM, Bozhkova SA, Shubnyakov II, editors. Materials of the Second International Conciliation Conference on musculoskeletal infection. St. Petersburg: RNIITO named after R.R. Vreden, 2019. 314 р. (In Russ).

[38] Материалы II Международной согласительной конференции по скелетно-мышечной инфекции / под общ. ред. Р.М. Тихилова, С.А. Божковой, И.И. Шубнякова. Санкт-Петербург: РНИИТО им. Р.Р. Вредена, 2019. 314 с.

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