Infections that can affect the hip are primarily either an infection of the bone ('osteomyelitis') or an infection of the joint ('septic arthritis'). Infection can either originate within the bones of the hip and the hip joint or can originate elsewhere in the body – often infections of the skin and soft tissue - and then subsequently affect the hip.
The three main types of infection that affect the bones and joints of the hip are:
- Osteomyelitis – this affects the bones.
- Septic arthritis – this affects the joints.
- Prosthetic Joint Infection – this affects the component parts (the 'prostheses') of an artificial hip replacement.
Infections of the hip are largely caused by micro-organisms such as bacteria (for example Staphylococcus Aureus - 'Golden Staph'), viruses and fungi, which get into the blood and travel to the bone tissue. This can happen in the following circumstances:
- Bone trauma.
- Bone surgery (including hip replacement surgery).
- Bone fracture infection.
- Infection from elsewhere in the body carried in the bloodstream or in the blood itself (e.g. skin infection, urinary tract infection, septicaemia).
Some people are more at risk of developing a hip infection, these include;
- People with existing joint conditions such as osteoarthritis, rheumatoid arthritis.
- People with other chronic conditions, for example sickle cell anaemia or cancer.
- People with poor blood circulation for example smokers, people with high blood pressure or diabetes.
- People with suppressed immune systems (medication for rheumatoid arthritis can have this effect).
- People with some skin conditions, for example psoriasis and eczema.
- People with skin injuries near a joint, for example puncture wounds (including due to injecting drugs), animal bites and / or cuts and abrasions.
Very young children and older adults are also at higher risk of contracting septic arthritis – roughly 45% of all people affected by septic arthritis are over 65.
The main symptom of hip infection is pain in the hip, often accompanied by:
- Swelling / redness.
- Tenderness / warmth.
- Difficulty moving the joint.
- Fever (38°C+).
- Sweating / chills.
- General feeling of being unwell.
- Otherwise unexplained loss of weight.
- Muscle spasms.
Tests / Diagnosis
After a physical examination and review of medical history, a number of tests may be required to diagnose suspected hip infections. These may include:
- Blood tests (to detect any blood borne infection).
- CT scan.
- MRI scan.
- Bone scan.
- Tissue biopsy from the bone.
- Joint fluid analysis (to detect infection in the synovial fluid surrounding the joint).
Most treatment involves a course of antibiotics to treat the infection which generally runs for 4-6 weeks. In some cases, the infected joint fluid may need to be drained, and surgery may be necessary to properly drain this fluid and flush the affected bone tissue (a process referred to as 'debridement' and / or 'lavage'). In very severe cases, amputation may be necessary.