Primary septic arthritis of the hip after COVID-19- A case series of six patients

Abstract

Abstract Background We aim to report the consecutive patients with primary septic arthritis of the hip associated with COVID-19 and elucidate its unique clinical and radiological features. Methods Six consecutive patients (7 hips) who recovered from COVID-19 and presented with acute hip pain from November 2020 to October 2021 were included. All the patients received corticosteroids as a supportive treatment during COVID-19. Patients were diagnosed with septic arthritis of the hip based on radiographs, MRI, inflammatory markers and hip aspiration culture and synovial fluid analysis. Harris hip score was used to evaluate the functional outcome before and after treatment. Results The mean age was 44.3 years (range, 31 to 54 years). The average cumulative dose of methylprednisolone equivalent was 1328.2 mg (range, 460 to 2500 mg) and the average duration of steroid intake was 3.3 weeks. Two were culture positive and the rest four patients had a culture-negative infection. There was a significant improvement in Harris hip score from 12.5 ± 7.1 at presentation to 72.3 ± 13.6 after treatment (p < 0.05). There was a marked reduction in inflammatory parameters compared to the presenting values after treatment. Four patients (5 hips) underwent debridement and antibiotic-loaded cement spacer application in the first stage and uncemented total hip arthroplasty in the second stage. Other two patients who were treated conservatively had post septic arthritis of the hip and awaiting total hip arthroplasty. Conclusion In patients presenting with acute hip pain after COVID-19 infection, primary septic arthritis should be one of the differential diagnosis. They have features like elevated serological markers and extensive periarticular bone and soft tissue edema. Preoperative hip aspiration is mandatory for diagnosis and the patient may require a two-stage procedure for eradication of infection.