An unusual case of hip pain after total hip arthroplasty: A case report

Abstract

Our goal is to draw attention to the inflammation of theiliopectineal bursa being a rare condition, which can cause lowerlimb swelling and anterior pain of the hip even years after totalhip arthroplasty. A 67-year-old woman was admitted seven yearsafter hip arthroplasty (cemented total endoprosthesis [TEP]) withswelling and feeling of excessive fullness of the lower extremityand with tolerable anterior hip pain. The physical examinationand blood tests were non-specific for septic condition. Ultrasoundshowed a cystic mass in the inguinal region with a direct contactto the common femoral vein. Deep vein thrombosis was excluded.The single-photon emission computed tomography-computedtomography (SPECT-CT) was administered to decide the surgicalplan, either making a bursa extirpation or making revisionhip arthroplasty. The SPECT-CT excluded the possibility ofaseptic loosening. Methylene blue was injected into the bursaintraoperatively which did not enter the strong pseudo-capsule ofthe joint and, therefore, we did not administer revision of the TEP,and the bursa was extirpated. Two weeks after the operation, thepatient had no pain, was able to walk, and the swelling decreased.Four months after surgery, the pain and feeling of fullnessdisappeared, with minimal lower limb swelling. In conclusion,in case of increasing complaints of patients who left yearsbehind without any problem following total hip arthroplasty, thepathogenic role of the iliopectineal bursa should be taken intoaccount, after excluding more frequent causes such as asepticloosening or periprosthetic joint infection. As long as we considerabout a rare disease, we can find a solution to the patient’scomplaint sooner.