This is the first clinical report of a
psoas abscess encountered during a routine
hemiarthroplasty surgery for a
femoral neck fracture in a man with a recent
urinary tract infection. There were no prior symptoms to suggest a
psoas abscess, which was present on the same side as the hip fracture, apart from a history of recurrent
urinary tract infection. The surgery had to be altered intraoperatively to that of an excision
arthroplasty of the displaced non-viable femoral head along with insertion of an
antibiotic-impregnated cement spacer into the hip joint. Relevant microbiological studies confirmed a
methicillin-sensitive Staphylococcus aureus
psoas abscess with bacteraemia in addition to Staphylococcus
bacteriuria, so 6 weeks of intravenous
antibiotics were started. A planned second-stage
hemiarthroplasty was undertaken and the patient recovered fully without complications. Primary
infection of the urinary tract by S. aureus is rare. This case serves to remind clinicians that caution must be exercised in patients with
recurrent infections, especially when such
infections affect organs or areas close to the intended surgery site. This warrants thorough evaluation for an occult source of
infection. A
psoas abscess is an unusual cause of hip
pain and accurate diagnosis relies on a high index of suspicion. The
antibiotic-impregnated articulating cement spacer is a useful surgical adjunct after excision
arthroplasty, it not only elutes a high concentration of
antibiotics in the infected field, but also facilitates second-stage
arthroplasty surgery by preventing muscle and soft tissue
contractures from developing.