A 42-year-old patient had undergone
total hip replacement for aseptic femoral head
necrosis 9 years previously. He now presented with loosening of the
prosthesis and
pseudoarthrosis sustained following a femoral shaft fracture 7 months earlier. A
total hip replacement was carried out in general anaesthesia combined with an epidural
catheter. The epidural
catheter was removed on the third postoperative day, after which the patient complained of persistent lumbar
pain which was associated with
meningismus,
fever, leucocytosis and a raised erythrocyte sedimentation rate. In spite of intensive laboratory and radiological investigation, 15 weeks elapsed before a radiological diagnosis of
spondylitis of L1 and L2 could be made. Aspiration biopsy of the L1/L2 disc space yielded a growth of Pseudomonas aeruginosa.
Antibiotic therapy was begun immediately but could not prevent spread of
infection to the adjacent disc-space T12/L1 and the vertebral body T12. The patient made a slow recovery and was discharged in a satisfactory condition wearing a lumbar
brace some 9 months after the operation. No evidence of
epidural abscess formation was found at any stage and no direct connection between the use of the epidural
catheter and
spondylitis could be established.