No abstract

Deep periprosthetic joint infection (PJI) is a severe complication after primary and revision hip joint arthroplasty resulting in multiple interventions on the joint. The present paper describes a rare case of early deep hip PJI of odontogenic etiology. The patient suffered from early PJI after a planned procedure of left hip joint arthroplasty. Antibacterial therapy without surgical debridement was performed in an outpatient unit which resulted in a late, on day 12th after surgery, admittance of the patient to hospital with continued administration of antibiotics. Treatment tactics was selected upon patient’s admission basing on patient complaints, medical history of the disease, clinical signs and findings of roentgenological, laboratory and bacteriological examinations. Two-stage treatment consisting of revision, removal of implant, debridement, biopsy and wound drainage by a swab was performed and followed by empiric antibacterial therapy (for 5 days). Targeted antibacterial therapy was prescribed basing on bacteriological test findings. Together with dentists the authors examined oral cavity of the patient, identified a site of chronic infection and undertook the focused treatment by dental extraction and sanitation of the oral cavity. Postoperative period after the first stage was uncomplicated. Second stage of revision (re-arthroplasty of left hip joint) was performed on week 36 of the surgical time-out with a good clinical outcome: 80 points on Harris hip score in 40 weeks after the second stage. Presented clinical case illustrates the existence of hematogenous mechanism of postoperative microorganism dissemination from the chronic infection nidus with subsequent progression of inflammation at the surgical site, including PJI. In the present case the Actinomyces odontolyticus was isolated from periprosthetic tissues and parodontal recesses which allowed the authors to suggest a highly probable cause for early PJI by Actinomyces odontolyticus translocation into periprosthetic tissues of the hip joint. However, strain sequencing is required for the complete verification. The described case confirms the need for debridement of chronic infection nidus prior to joint arthroplasty aiming at prevention of hematogenous periprosthetic infection.

Background. Periprosthetic joint infection in the early postoperative period is a severe infectious complication. Its development, as a rule, is associated with the exogenous surgical wound infection, with the iatrogenic factor at the forefront. Clinical case description. A 73-years-old female with left-sided idiopathic 3rd stage hip osteoarthritis and concomitant pathology with a high degree of comorbidity underwent left hip arthroplasty with a cement-fixed “Endoservice” endoprosthesis. In the early postoperative period (4th to 6th days), against the background of chronic calculous cholecystitis exacerbation and gastrointestinal dysfunction, clostridial septicemia developed as a result of bacterial translocation. The timely diagnosis of the endogenous nature of this infection and the targeted antibiotic therapy prevented the surgical wound and endoprosthesis infection. The Harris score for the function of the left hip at discharge was 78 points. Conclusion. The presented clinical case demonstrates the importance of careful preoperative planning, especially in the patient with identifying somatic pathology of infectious nature, the need to detail the organ-specific microbiota as a mandatory procedure, as well as the prevention of periprosthetic joint infection during orthopedic operations, taking into account the data obtained.