gms | German Medical Science

We report a case of a 63 year old female admitted to our department with a chronic wound infection of the right hip as well as a dislocated hip prothesis into the colon (Coecum) with a consecutive dislocation of the artificial hip socket into the rectum. The patient’s previous history revealed a status post internal right hemipelvectomy as well as a resection of the right proximal femur for schwannoma of the pelvis; in the realm of which a hip prothesis was implanted and an artificial hip socket reconstructed. The post surgical course was complicated by a local joint infection including the prosthesis necessitating repeated surgical revisions, drainage and lavage.

On admission to our hospital, the patient presented with rectal pain and stool irregularity. Our clinical and radiographic findings revealed the hitherto mentioned dislocations as well as a complete afunctional right hip joint. The artificial hip socket was immediately removed from the rectum. This was only possible under endotracheal anesthesia. In view of the persistent nature of the right hip infection especially the chronic osteomyelitis in spite of a long lasting history of adequate antiinfective therapy and in cognizance of the afunctionality of the right leg, we elected on a major surgery, tantamounting in inter alia a wedge resection of the Coecum with removal of the dislocated prosthesis and an exarticulation of the right limb at the hip with subsequent formation of a myocutaneous flap from the right quadriceps femoris muscle, which was then used to cover the right hip defect. The postoperative course was uneventful and the patient was discharged on POD 43.