Presentation
Multiple days of worsening pain in the left hip, groin and leg. Total hip replacement recommended.
Patient Data
Status post left hip hemiarthroplasty with cementing of the acetabular component. The hardware appears intact and well-seated. Antibiotic beads project over the left hip. Expected surrounding postsurgical changes include soft tissue edema, subcutaneous emphysema, and surgical staples overlying the proximal left thigh.
Redemonstrated total right hip arthroplasty. The hardware appears intact and well-seated in a single AP view.
Persistent widening of the SI joints with chronic erosions at the inferior aspects of bilateral SI joints, likely sequelae of prior septic arthritis.
Redemonstrated a left-sided fat-containing inguinal hernia.
The pubic symphysis is maintained without evidence of widening.
Partially visualized intervertebral cage in the L5-S1 disc space.
A few pelvic phleboliths. Two linear metallic densities overlying the lower pelvis, likely embolization material.
Case Discussion
This represents a case of total hip replacement. The patient presented to the emergency department with worsening pain in the left hip, groin, and leg. Imaging workup demonstrated effacement of the acetabulum, effacement of the femoral head, and significant evidence of septic arthritis on MRI. Due to bony destruction, it was recommended that the patient undergo placement of an antibiotic-laden total hip arthroplasty, as shown above.
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