|ECR 2013 / C-2543|
|Septic arthritis of the pubic symphysis: Report of 5 cases and review of literature|
Septic arthritis or osteomyelitis of the pubis is the infection that involves the pubic symphysis.
It is a rare condition,
representing less than 1% of osteomyelitis and its true incidence is unknown.
approximately 200 cases have been reported in the literature.
It was first described in 1924 by Beer et al, as a postoperative complication of a prostatectomy.
The largest series identified 100 cases. In this review, a high prevalence of osteomyelitis was present: it was seen in 97% of the 100 patients.
Septic arthritis affects pubic majority of adults (mean age: 61 years). No sex differences have appreciated.
The described predisposing factors include history of genitourinary surgery,
sports that require adduction of the hips,
history of pelvic neoplastic processes,
addiction to intravenous drugs,
and previous cardiac catheterization.
The etiology is variable depending on the risk groups, and they are generally S. aureus and Pseudomonas aeruginosa, which are the microorganisms most prevalent in our series.
In cases with previous pelvic surgery, is common a polymicrobial flora (20%).
The differential diagnosis should be done especially with osteitis pubis (also named pubic dynamic osteopatia),
which is a sterile condition of the symphysis pubis seen more commoly in athletes and active people.
All our patients had symptoms highly suggestive of this condition, with inflammatory pubic pain radiating to the thighs, difficulty in mobilizing the hip and limitation in ambulation. Fever, present in 5 of our patients, appears in up to 75% of cases reported in the literature.
The clinical presentation can be insidious, so the diagnosis may be delayed (up to 1 month on average in the literature and 10 days in our series).
Leukocytosis appears only in a third of the reported cases in the literature.
The most common complications include abscess formation and extension to adjacent structures (mainly adductor muscles or pelvis), as seen in three of our patients. Mortality linked to the process is 2%.
Imaging techniques offer little specificity in isolation, and may be strictly normal in early stages. Scintigraphic uptake is suggestive in case of clinical suspicion, whereas CT and MRI provide more accurate information.
Given the low frequency of the process, the initial clinical suspicion is essential for diagnosis.
Imaging findings and microbiological evidence of infection, either by positive blood cultures or bone biopsy in cases of doubt, lead to the diagnosis. The prolonged antibiotic treatment, not less than 4-6 weeks, with early debridement of the purulent to prevent subsequent joint instability, provides satisfactory results.