Fistula between the hip and a diverticular abscess after revision total hip replacement

Total hip arthroplasty for post-firearm hip arthritis complicated by coloarticular fistula: A case report

Hip firearm injuries are rare injuries that could lead to serious complications, such as posttraumatic hip arthritis and coloarticular fistula. We report a case of a 25-year-old male who sustained a pelvic injury caused by a single bullet which led to a bilateral acetabular fracture, concomitant with a colon injury treated on an emergency basis by a diverting colostomy; acetabular fractures were treated conservatively by traction. After the patient recovered from the abdominal injury, he was presented with bilateral hip pain and limited motion; plain radiographs showed bilateral hip arthritis with proximal migration of the femoral head and bilateral acetabular defect classified as Paprosky type ⅢA. Reconstruction of the hips was performed using the same technique: impaction bone grafting for acetabular defect reconstruction and a reversed hybrid total hip arthroplasty (THA) 6 months apart. The patient presented with loosening of the left THA acetabular cup 3 years later, which was revised; then he presented with a discharging sinus from the left THA with suspicion of coloarticular fistula, which was confirmed using CT with contrast material. A temporary colostomy and fistula excision were performed, and a cement spacer was applied to the hip. After clearing the infection, a final revision THA for the left hip was performed. Treating post-firearm hip arthritis by THA is challenging, especially in the situation of neglected cases with the presence of an acetabular defect. Concomitant intestinal injury increases the risk of infection with the possibility of coloarticular fistula formation, which could present later. Working with a multidisciplinary team is paramount.

An Enteric Fistula to a Hip Fusion Mass, 30 Years After the Arthrodesis: A Case Report

CASE

In this report, we describe a case of delayed enteric fistula to the hip fusion mass, 30 years after the hip fusion surgery with confusing symptoms at presentation.

CONCLUSION

Fistula formation between bowel and the hip joint after a hip surgery is rare. Enteroarticular fistula can be fatal because of sepsis. The enteric fistula to the hip joint diagnosis may not always be straight forward, and it should be kept in mind as a probable differential diagnosis in many unrelated scenarios. Complete physical examination, preoperative sampling, paying attention to the intermittency of secretions during starvation, and timely consult with general surgeons can help.

Enteroarticular Fistula Following Antibiotic Spacer Placement for a Periprosthetic Joint Infection in a Patient with Chronic Pelvic Discontinuity: A Case Report

CASE

A 50-year-old man with a history of chronic refractory periprosthetic joint infection following total hip arthroplasty, which had been treated with multiple antibiotic spacers, developed an enteroarticular fistula. He was able to avoid hip disarticulation after undergoing a laparoscopic colectomy with a diverting colostomy and a functional hip resection arthroplasty. At the 1-year follow-up, he was walking independently with crutches and had minimal pain.

CONCLUSION

An enteroarticular fistula following total hip arthroplasty is a rare and serious complication. To our knowledge, this is the first reported case that occurred in the setting of an antibiotic spacer. A multidisciplinary team approach is essential for achieving clinical success.

Coloarticular fistula: A rare complication of revision total hip arthroplasty

Fistula formation between bowel and total hip arthroplasty or revision arthroplasty hardware is rare. We present a case of a 78-year-old woman with protrusio of left hip arthroplasty and acetabular reconstruction hardware that caused direct perforation of the sigmoid colon and fistula formation between the sigmoid colon and the left hip joint. The patient underwent several joint debridements, sigmoid colectomy, and removal of all orthopedic hardware; she ultimately died after two prolonged hospitalizations.

'Pointing' in the wrong direction--a case of diverticulitis presenting at the hip

We report the case of a 73-year-old lady who was seen with an infected sinus leaking from the wound of a recently inserted right total hip joint prosthesis. Plain radiographs revealed gas shadows in the region of the wound. An intra-operative sinogram showed the sinus to be coming from a pelvic diverticular abscess and the hip to be an innocent bystander. Our case emphasises the importance of having a clear preoperative plan with relevant investigations before a radical operative procedure is undertaken, to avoid unnecessary risk to a non-infected hip prosthesis.

[Therapy-resistant periprosthetic abscess of the hip of unknown cause]

Two months after total endoprosthesis of the hip (Spotorno) a 60-year-old obese female patient complained about increasing hip pain. Costly diagnostic measures could not clarify the cause. Analgesic therapy administered with local cortisone injections was not satisfactory. Upon deterioration of her general condition the patient was hospitalized. A periprosthetic abscess of the hip with atypical muscle necrosis could not be controlled after several interventions. Computed tomography of the abdomen and hip revealed a jejunoacetabular fistula after mesenteric perforation with small intestine diverticulosis. It seems to be the first published case. After abdominal and hip surgery the further course was good. There was no need to replace the prosthesis. Retroperitoneal abscess with purely coxal symptomatology has been described. Diverticulitis of the small intestine has a poor prognosis. When infections with unusual necrosis resistant to therapy after hip prosthesis surgery occur, consideration must be given to retroperitoneal abscess. Abdominal tomography allows the life-saving surgery.