Iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal-on-metal hip arthroplasty. A case series
Background: A prosthetic joint infection is a devasting diagnosis and challenging condition to treat. The aim of this study is to outline the investigations, management and outcomes in a series of patients who presented to our institution with an iliopsoas abscess (IPA) in the setting of an infected...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-12-01
|
| Series: | Journal of Orthopaedic Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773157X24000353 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850122829300760576 |
|---|---|
| author | David O'Sullivan Mark Curtin Shane P. Russell Colin G. Murphy |
| author_facet | David O'Sullivan Mark Curtin Shane P. Russell Colin G. Murphy |
| author_sort | David O'Sullivan |
| collection | DOAJ |
| description | Background: A prosthetic joint infection is a devasting diagnosis and challenging condition to treat. The aim of this study is to outline the investigations, management and outcomes in a series of patients who presented to our institution with an iliopsoas abscess (IPA) in the setting of an infected, metal-on-metal (MoM), hip arthroplasty. Case details: Six patients with an IPA associated with an ipsilateral MoM presented over four years. Medical history, serum markers, trimodal imaging, aspirations and surgical procedures performed were analysed The management algorithm employed is outlined.Five were diagnosed with culture positive prosthetic joint infections (PJI). Four patients had elevated Cobalt and Chromium levels and all patients had characteristic aseptic lymphocytic vasculitis (ALVAL) associated lesions on Magnetic Resonance Imaging. Four proceeded to two stage revision. One patient opted for lifelong antibiotic suppression therapy. Four patients who opted for revision surgery had an infection free survival at mean 6 years. Conclusions: Our case series describes a rare, but significant consideration in the practice of the modern arthroplasty surgeon and a successful management strategy to treat these cases. Surgeons should be mindful of the potential concurrent presence of a PJI in cases of an IPA in the context of a total hip replacement, but especially for MoM, where concomitant malignancy, ALVAL, and metallosis are frequently implicated. |
| format | Article |
| id | doaj-art-eb7e5eaa6b9b44a7833eaca49e015051 |
| institution | OA Journals |
| issn | 2773-157X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Reports |
| spelling | doaj-art-eb7e5eaa6b9b44a7833eaca49e0150512025-08-20T02:34:44ZengElsevierJournal of Orthopaedic Reports2773-157X2024-12-013410034010.1016/j.jorep.2024.100340Iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal-on-metal hip arthroplasty. A case seriesDavid O'Sullivan0Mark Curtin1Shane P. Russell2Colin G. Murphy3Department of Trauma and Orthopaedics, Galway University Hospitals, Newcastle Road, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; Corresponding author. Department of Trauma and Orthopaedics, Galway University Hospitals, Newcastle Road, Galway, Ireland.Department of Trauma and Orthopaedics, Galway University Hospitals, Newcastle Road, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, IrelandDepartment of Trauma and Orthopaedics, Galway University Hospitals, Newcastle Road, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, IrelandDepartment of Trauma and Orthopaedics, Galway University Hospitals, Newcastle Road, Galway, IrelandBackground: A prosthetic joint infection is a devasting diagnosis and challenging condition to treat. The aim of this study is to outline the investigations, management and outcomes in a series of patients who presented to our institution with an iliopsoas abscess (IPA) in the setting of an infected, metal-on-metal (MoM), hip arthroplasty. Case details: Six patients with an IPA associated with an ipsilateral MoM presented over four years. Medical history, serum markers, trimodal imaging, aspirations and surgical procedures performed were analysed The management algorithm employed is outlined.Five were diagnosed with culture positive prosthetic joint infections (PJI). Four patients had elevated Cobalt and Chromium levels and all patients had characteristic aseptic lymphocytic vasculitis (ALVAL) associated lesions on Magnetic Resonance Imaging. Four proceeded to two stage revision. One patient opted for lifelong antibiotic suppression therapy. Four patients who opted for revision surgery had an infection free survival at mean 6 years. Conclusions: Our case series describes a rare, but significant consideration in the practice of the modern arthroplasty surgeon and a successful management strategy to treat these cases. Surgeons should be mindful of the potential concurrent presence of a PJI in cases of an IPA in the context of a total hip replacement, but especially for MoM, where concomitant malignancy, ALVAL, and metallosis are frequently implicated.http://www.sciencedirect.com/science/article/pii/S2773157X24000353ArthroplastyProsthetic joint infectionPseudotumourRevision arthroplastyMetal-on-Metal |
| spellingShingle | David O'Sullivan Mark Curtin Shane P. Russell Colin G. Murphy Iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal-on-metal hip arthroplasty. A case series Journal of Orthopaedic Reports Arthroplasty Prosthetic joint infection Pseudotumour Revision arthroplasty Metal-on-Metal |
| title | Iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal-on-metal hip arthroplasty. A case series |
| title_full | Iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal-on-metal hip arthroplasty. A case series |
| title_fullStr | Iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal-on-metal hip arthroplasty. A case series |
| title_full_unstemmed | Iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal-on-metal hip arthroplasty. A case series |
| title_short | Iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal-on-metal hip arthroplasty. A case series |
| title_sort | iliopsoas abscess and adverse reactions to metal debris in the setting of an infected metal on metal hip arthroplasty a case series |
| topic | Arthroplasty Prosthetic joint infection Pseudotumour Revision arthroplasty Metal-on-Metal |
| url | http://www.sciencedirect.com/science/article/pii/S2773157X24000353 |
| work_keys_str_mv | AT davidosullivan iliopsoasabscessandadversereactionstometaldebrisinthesettingofaninfectedmetalonmetalhiparthroplastyacaseseries AT markcurtin iliopsoasabscessandadversereactionstometaldebrisinthesettingofaninfectedmetalonmetalhiparthroplastyacaseseries AT shaneprussell iliopsoasabscessandadversereactionstometaldebrisinthesettingofaninfectedmetalonmetalhiparthroplastyacaseseries AT colingmurphy iliopsoasabscessandadversereactionstometaldebrisinthesettingofaninfectedmetalonmetalhiparthroplastyacaseseries |