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

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.