[Infection of the hip joint following psoas abscess. Case report and literature review]

[Etiology and classification of septic coxitis]

Septic coxitis is a rare disesase which can be caused by a variety of pathogens. Primary and secondary coxitis can be differentiated depending on the etiology. In the initial stages the diagnosis is difficult but a delay in making the correct diagnosis or delayed therapy can result in fatal consequences for the patient, therefore, therapy should be started even in cases of suspected septic coxitis. Septic coxitis is classified into four stages depending on the arthroscopic findings. The best results are usually achieved by a combination of arthroscopic lavage and antibiotic therapy.

[Septic arthritis as an initial manifestation of a bacterial endocarditis]

Septic arthritis due to endocarditis is a rare and life-threatening disease. Endocarditis occurs with an incidence of 30 patients per 1 million citizens/year. Staphylococcus aureus is one of the most common causative pathogens. Methicillin-resistant Staphylococcus aureus (MRSA) can lead to a severe outcome with a high mortality rate, and embolic complications of the kidney, brain, and spleen are seen in one third of all cases. The diagnosis and treatment of endocarditis is a challenge for all health care providers. We report about a patient who was admitted to our hospital with generalized sepsis of unknown origin.

Metallosis, psoas abscess and infected hip prosthesis in a patient with bilateral metal on metal total hip replacement

Metal on metal hip (MoM) resurfacing / replacement has recently been one of the most discussed topics in orthopaedics. Significant revision rates and complications are associated with MoM. We report a patient presenting with infection of a total hip prosthesis in conjunction with a psoas abscess in which the presentation is complicated by radiological evidence of suspected metallic debris in the lower limb tissues and elevated chromium and cobalt levels, suggestive of metallosis secondary to MoM.

[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.