title: Bilateral prosthetic hip joint infections associated with a Psoas abscess. A Case Report.
abstract: BACKGROUND
  Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections.
  
  
  METHODS
  We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip. He then developed an infected right thigh haematoma, which also formed a discharging sinus connecting to the right hip post-drainage. He was treated with bilateral two-stage revision total hip arthroplasties and multiple courses of prolonged antibacterial therapy. Both abscesses and hip joints cultured the same species of multi-sensitive Staphylococcus aureus. The causal link between the psoas abscess and the prosthetic hip infections is discussed, as well as the investigation and management.
  
  
  CONCLUSIONS
  We recommend routine exploration of the iliopsoas bursa when revision of an infected total hip arthroplasty is performed to rule out intrapelvic spread of the infection [3]. There should be high index of suspicion of prosthetic hip infection in patients presenting with Psoas abscess and vice versa. A CT scan might be warranted to rule out concomitant infection in both these patients.
authors.affiliation: Department of Orthopaedic Surgery Registrar Royal Perth Hospital, Perth, Australia.
authors.forename: G D Rajitha
authors.initials: GD
authors.lastname: Gunaratne
authors.affiliation: Department of Computer Science and Engineering, Curtin University of Technology, Perth, Australia; The University of Notre Dame, Perth, Australia; The Joint Studio, Perth, Australia.
authors.forename: Riaz J K
authors.initials: RJ
authors.lastname: Khan
authors.affiliation: Hollywood Private Hospital, Perth, Australia.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Tan
authors.affiliation: Department of Infectious Diseases, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Clayton
authors.initials: C
authors.lastname: Golledge
keywords: Psoas abscess; hip arthroplasty; prosthetic hip joint infection