Hip Ankylosis after Untreated Septic Arthritis by Escherichia coli: A Case Report

Abstract

Septic arthritis is usually reported in elderly patients with other underlying medical conditions. Septic arthritis by Escherichia coli is a rare infection. We are describing the case of a 70-years old patient who presented with a suppurative fistula, limited movements of the right lower limb, and a trauma that occurred at the age of 12. Throughout this time, the fistula had been present, secreting pus. A detailed clinical investigation revealed a pyogenic infection present in the femoral epiphysis followed by an elevated sedimentation rate. After the surgical intervention, E. coli was isolated from the clinical samples, and the decision to place gentamicin beads within the surgical wound was taken. The patient was treated with antibiotics. Four months after the intervention, the suppurative fistula was completely healed.

Later on, the patient was no longer interested anymore in continuing with the treatment plan. As he refused to remove the gentamicin chain beads and the hip endoprosthesis, he was subsequently referred to the primary care clinic for conservative management and follow-up. He walked with a limp wearing orthopedic shoes and not using crutches or any other type of walking-aid. Four years after the surgical intervention, the gentamicin chain beads are still within the bone. Septic arthritis caused by E. coli can remain active for decades, secreting pus and self-isolating. Prompt diagnosis, adequate surgical intervention, and antimicrobial therapy are essential for the treatment.

Keywords
ankylosis; arthritis, infectious; hip joint; Escherichia coli