Lumbar facet joint septic arthritis presenting atypically as acute abdomen - A case report and review of the literature.

INTRODUCTION: Septic arthritis of the lumbar facet joints is uncommon. The clinical presentation is unusual and patients usually presents with acute back pain or with signs and symptoms mimicking acute abdomen. PRESENTATION OF CASE: A 52year old man was admitted to the surgical ward with acute onset of abdominal pain and a provisional diagnosis of acute pyelonephritis. After the initial inconclusive investigations, magnetic resonance imaging was highly suggestive of lumbar facet joint septic arthritis. He was treated with intravenous antibiotics with complete resolution of infection. DISCUSSION: The diagnosis of septic arthritis of facet joint is becoming more common with MRI scans. The clinical signs and symptoms are usually difficult to differentiate from acute spondylodiscitis. The commonest organism isolated is Staphylococcus aureus. A prompt and early diagnosis and treatment help to eradicate infection and prevent complications. CONCLUSION: The atypical presentation of facet joint septic arthritis is one of the reasons why early diagnosis is elusive. Definitive diagnoses with MRI and bacterial culture as well as prolonged antibiotic therapy are recommended in this condition.

Dislodgement of a cemented exeter femoral stem during closed manipulative reduction of a dislocated total hip replacement.

INTRODUCTION: The incidence of cemented femoral stem migration and dislodgement even though has been described is extremely unusual. There is a high chance of polished femoral stem displacement happening while trying to reduce a dislocated total hip replacement by closed measures. PRESENTATION OF THE CASE: A 73 year old lady who had an Exeter cemented total hip replacement about two weeks back was admitted from Accident and Emergency with a dislocation. During the closed manipulative reduction under general anaesthesia it was noted that the femoral stem has dislodged from the canal. She underwent revision of the total hip replacement with good outcome. DISCUSSION: Femoral stem dislodgement occurs in total hip replacement if polished stem or inadequate cementing of the collar is carried out. CONCLUSION: Gentle manipulative reduction under general anaesthesia of dislocated total hip replacement should be carried out if the polished femoral stem is used.