Septic hip after a fractured neck of femur in a rheumatoid patient: A case report.

A 63-year-old rheumatoid patient presented with severe pain in her left hip without a preceding history of trauma. An initial clinical and radiological examination revealed no "obvious" abnormality and the patient was symptomatically treated. The patient presented again five weeks later as weightbearing became increasingly difficult due to worsening pain. Inflammatory markers were found to be elevated and a repeat radiological examination revealed a displaced ununited fracture of the neck of femur. Isotope imaging suggested increased activity around the hip. A formal arthrotomy revealed pus in the joint. She continued to deteriorate and subsequently died due to sepsis. Spontaneous fractures without any history of trauma have been described in patients with rheumatoid arthritis. The fracture haematoma serves as a good culture medium for micro-organisms in immuno-compromised rheumatoid patients. Any hip pain arising in a rheumatoid patient should be thoroughly investigated and a high index of suspicion is necessary for both sepsis and fracture. (Hip International 2005; 15: 59-61).