Chronic intra-pelvic migration of an infected hip arthroplasty in a young male sickle cell patient

Intra-pelvic migrations of infected total hip implants are extremely rare and challenging complications. We present the case of a 30-year-old man who was referred from a sub-Saharan African country with these complications. This is a known sickle cell patient with a history of hip arthrosis due to multiple episodes of vaso-occlusive crises. He was operated on the right total hip arthroplasty 18 months before his referral. He reported a progressive unset of the pain of his right hip associated with a progressive shortening of his right lower limb and a discharge of pus from the operation site, in an apyretic context that started eight months after the surgery. He could walk with two crutches. Physical examination revealed a fistula with purulent discharge on the operation site, and a shortened right lower limb (3.5cm difference) with normal distal neurovascular examination. Waist X-ray and computed tomography showed intra-pelvic dislocation of the hip implant with deviation of right iliac arteries. A computed tomography angiogram revealed permeable right iliac arteries. C-reactive protein (CRP) was at 137mg/L with normal white blood cell count. Before implant removal, debridement, collecting samples for cultures, thorough lavage, and spacer placement, a two-week distal femoral gradual pin traction was done. <i>Staphylococcus aureus</i> sensitive to Imipenem and Amikacin was isolated, and the patient received bi-anti biotherapy for infection control as per the protocol, after which a new cemented prosthesis was reimplanted. At the last follow-up (two years), the patient had equal lower limb lengths, walked with one crutch, and had no sign of infection at the operation site.