Ann Rehabil Med.  2015 Jun;39(3):498-503. 10.5535/arm.2015.39.3.498.

Osteomyelitis of Bilateral Femoral Heads After Childbirth: A Case Report

• Lee KS
• Kong S
• Kim J
• Kim T
• Choi CB
• Kim YS
• Lee KH

• KMID: 2165656
• DOI: http://doi.org/10.5535/arm.2015.39.3.498

Abstract

Hip and pelvic pain during pregnancy or after delivery is a common problem in young females, and in most cases this problem has a self-limiting course. The patient described in this case suffered from severe hip pain after childbirth. MR imaging study was performed and it showed arthritis of bilateral hip joints and osteomyelitis of femoral heads with an abscess in the surrounding muscle. Infection, such as septic arthritis or osteomyelitis, is an extremely rare cause of peripartum joint pain. The patient's clinical symptoms and laboratory findings improved with antibiotic therapy. However, limitation of motion of the bilateral hip joints persisted although the patient continued rehabilitative therapy for 15 months, and the patient had to undergo bilateral total hip replacement. Hereby, we present a case of severe osteomyelitis and pyogenic arthritis of bilateral femoral heads and hip joints after delivery, which eventually required bilateral total hip replacement.

Keyword

Osteomyelitis; Pregnancy; Total hip replacement

MeSH Terms

Abscess
Arthralgia
Arthritis
Arthritis, Infectious
Arthroplasty, Replacement, Hip
Female
Head*
Hip
Hip Joint
Humans
Magnetic Resonance Imaging
Osteomyelitis*
Parturition*
Pelvic Pain
Peripartum Period
Pregnancy

Figure

• 

  Fig. 1 Magnetic resonance images of the sacroiliac joint. Coronal enhanced T1-weighted image shows osteomyelitis of bilateral femoral heads (A), and transverse enhanced T1-weighted image showed left sacroiliitis (arrow), and a suspicious abscess in the left iliacus muscle (arrow head) (B).

• 

  Fig. 2 Magnetic resonance images of bilateral hips at one month after delivery. Coronal T2-weighted image shows a suspicious abscess in the right pectineus muscle (A), bilateral hip joint space narrowing with cortical destruction (arrow head), and surrounding soft tissue edema with enhancement and bilateral hip joint effusion (arrow) (B).

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  Fig. 3 Magnetic resonance images at four months after delivery. Coronal T2-weighted image demonstrates slightly decreased marrow signal in the left hip (arrow) and a decrease in joint effusion and adjacent soft tissue edema of the right hip (arrow head) (A) but a slight aggravation of the depressed lesion on the anterosuperior aspect of the right femoral head (arrow) (B).

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  Fig. 4 A radiograph of the hips shows sclerotic changes with flattening of the bilateral femoral heads and joint space narrowing.

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  Fig. 5 Gross specimens (A, B) shows a marked erosive lesion of the cartilage surface. Microscopic examination (C, D) revealed mild infiltration of lymphocytes and plasma cells in the medullary space (×400).

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