I'm treating a patient who, after a hip prosthesis revision, due to elevated cobaltemia and pseudotumor (ASR), now presents a persistent Hip joint effusion with pain that increases.
Infection is excluded.
We drained the fluid several times with temporary resolution of the symptoms but in a few days the situation returns as previously.
If the revision is done with again ChroomCobalt prosthesis or head of CoCr there can be a factor of allergy. If the tuissue was not enough debrided there still can be a toxic factor for fluid. If the prosthesis is polyethylene, there can be rapid wear.
Infection can be difficult to exclude!
At the end... The prosthesys was infected. Thank you for The suggestions.
As far as I understod the first cultures were negative. In similar cases one should suspect anaerobic infection. Were the cultures for anaerobic flora also negative ? Anyway, I always think at first for infection (Exclusion is dificult as Koen Smet underlines), and then for allergy or other reasons.
Dear Nicola, if you ever still do aspirations of such joints, have a WBC count done and WBC differentiation. High WBC count and large number of granulocytes/neutrophiles give indication for infection; very high lymfocytes with smaller WBC count can give hint for allergy
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