Methicillin-sensitive Staphylococcus aureus Infection After Steroid Hip Injection

Infection after intra-articular steroid injection of the hip is rare, occurring in <1 of 15,000 cases. Septic arthritis following intra-articular injection is even rarer. This is the only documented case of systemic septicemia following intra-articular injection. The patient received an intra-articular steroid injection to the left hip under fluoroscopic guidance, which resulted in reduced pain and increased mobility. Two weeks after the injection, the patient noticed sharp pain in the left hip and groin and malaise. Over a 48-hour period, he became progressively ill and was hospitalized for severe groin and thigh pain, inability to extend his hip, and diaphoresis. He underwent aspiration of the hip, which revealed Gram-positive cocci in clusters. At admission, the patient underwent incision and drainage of the left hip with removal of approximately 25 cc of fluid. The patient was started on intravenous vancomycin, then converted to nafcillin as the cultures and sensitivities revealed methicillin-sensitive Staphylococcus aureus. After 6 days of intravenous methicillin, the blood cultures were negative, and the patient was discharged. The patient's laboratory findings were normal, and cultures for aerobic anaerobic bacteria were negative. The patient underwent hip resurfacing and aggressive rehabilitation and was able to return to work. Thirty months after hip resurfacing, the patient had no evidence of infection, walked without a limp, had normal laboratory findings, and was pain free.