PMC6022300_01
CT: right iliopsoas abscess with calcifications and air (arrowhead).
CRIOR2018-9706065.001.jpg
PMC6022300_01_CRIOR2018-9706065.001.jpg
fig1
A computed tomography (CT) scan of her right hip revealed two partly calcified soft tissue masses associated with the right iliopsoas and obturator internus muscles (Figure 1).
MRI right hip. Large air- and fluid-filled collection tracking along the iliopsoas bursa and psoas muscle (arrowhead).
CRIOR2018-9706065.002.jpg
PMC6022300_01_CRIOR2018-9706065.002.jpg
fig2
An MRI of the right hip showed a large air- and fluid-filled collection tracking along the iliopsoas bursa and psoas musculature into the pelvis (Figure 2).
Axial and coronal CT scan showing excessive medialization of the acetabular component.
CRIOR2018-9706065.003.jpg
PMC6022300_01_CRIOR2018-9706065.003.jpg
fig3
This collection communicated with the hip prosthesis, and on CT imaging, the acetabulum component appeared to be medialized beyond the medial wall of the acetabulum as depicted in Figure 3.
Stage 1: postoperative XR right hip.
CRIOR2018-9706065.004.jpg
PMC6022300_01_CRIOR2018-9706065.004.jpg
fig4
Temporary components were replanted with an antibiotic impregnated cement spacer system (Figures 4 and 5).
Stage 1: postoperative CT scan.
CRIOR2018-9706065.005.jpg
PMC6022300_01_CRIOR2018-9706065.005.jpg
fig5
Temporary components were replanted with an antibiotic impregnated cement spacer system (Figures 4 and 5).
Flow of contrast dye tracking along the iliopsoas bursa into the hip joint.
CRIOR2018-9706065.006.jpg
PMC6022300_01_CRIOR2018-9706065.006.jpg
fig6
IR was consulted for drain placement and serial debridements, which were conducted with a rotating basket Trerotola device over the course of the next four weeks. In Figure 6, contrast dye can be seen tracking from within the iliopsoas abscess into the hip joint.
A custom-fitted temporary prosthesis.
CRIOR2018-9706065.007.jpg
PMC6022300_01_CRIOR2018-9706065.007.jpg
fig7
Four weeks following her explantation, the patient returned to the operating room for placement of a second temporary weight bearing custom-fitted prosthesis made from methyl methacrylate with gentamicin-impregnated antibiotics (Figures 7 and 8).
XR right hip. Stage 2: temporary prosthesis.
CRIOR2018-9706065.008.jpg
PMC6022300_01_CRIOR2018-9706065.008.jpg
fig8
Four weeks following her explantation, the patient returned to the operating room for placement of a second temporary weight bearing custom-fitted prosthesis made from methyl methacrylate with gentamicin-impregnated antibiotics (Figures 7 and 8). X-rays revealed her temporary prosthesis to be stable, but with radiolucencies primarily around the femoral component (Figure 8).
XR right hip. Radiolucencies around the femoral component (arrowhead).
CRIOR2018-9706065.009.jpg
PMC6022300_01_CRIOR2018-9706065.009.jpg
fig9
The patient was taken to the operating room, the temporary prosthesis was removed, and a long porous coated system was inserted (Figure 9).
XR right hip. Long porous coated system.
CRIOR2018-9706065.010.jpg
PMC6022300_01_CRIOR2018-9706065.010.jpg
fig10
Her final construct is shown in Figure 10.