What is a Hip Joint Abscess?
Hip joint abscess is a condition in which, the hip or the skin around it may be affected with infections or certain conditions that cause accumulation of pus in and around the hip joint. Abscess or building up of pus can occur around the hip joint or the soft tissues around it, which include ligaments, muscles and other tissues. Abscess of the hip joint can also be present over the skin surface, which can be easily visible.
While there are various factors affecting the occurrence of abscess, a common cause of joint abscess may be infections. Hip infections can cause hip joint abscess and they may affect some people, hence it is important to evaluate any case of hip joint abscess carefully. Hip joint abscess can affect anyone, at any age including children and some factors can increase the risk of hip infections or abscess.
It is important to know the causes and symptoms of hip joint abscess to detect a possible abscess around the hip joint. Along with a definite diagnosis of hip joint, appropriate treatment and wound care too, plays an important role in managing the condition. Any other factors contributing to the occurrence or recurrence of hip joint abscess, must be identified and corrected as well.
Causes of Hip Joint Abscess
Some of the common causes of hip joint abscess include
Hip Joint Abscess Caused Due to Injury
Injury to the skin or deeper wounds around the hip joint is one of the common causes of hip abscess. A minor cut or deeper tissue injuries, if not treated properly in time, can be a potential site of infection, which can cause pus collection in the area. Hip joint abscess can be caused by injuries to the hip joint, fractures of the pelvis or leg bones, foreign body, penetrating wounds, animal, insect or dog bites and even burns or scalds. These injuries can cause damage to the skin surface, subcutaneous tissues or to the deeper tissues. Injury to the hip joint or to the surrounding tissues include injured muscles, inflamed tendons, bursa, or ligament tear.
Improper wound care after injuries can cause infections, which can even affect the muscles and other structures supporting the hip joint. The commonest cause of infected wounds is bacterial infection, however, other microorganisms may too sometimes cause abscess in the hip joint after injuries.
Hip Joint Abscess Caused Due to Skin Infections
Skin infections are another common causes of hip joint. Skin eruptions, skin diseases and other skin problems, which can affect the skin surface around the hip, pelvis and groin region. Skin lesions like boils, carbuncles, cellulitis and skin abscess are potential sites for infections. These skin infections can be seen over the hip joint area, on the back of the hips, thighs or in the groin. When skin lesions get infected, pus formation results and can cause an abscess over the hip joint. Sometimes, such skin infections increase the risk of spreading the infection to the deeper tissues and can cause hip joint abscess.
Hip Infections and Septic Arthritis
Hip joint is a main weight bearing joint and is also at risk of injuries and infections. Many people with a fracture of injury of the hip joint may have to undergo a surgery or have a prosthesis, which can be at risk of septic arthritis. Septic arthritis of the hip can be a cause of hip joint abscess. Septic arthritis is an infection in the joint, which causes inflammation in one or more joint. It is a form of arthritis or inflamed joint, caused due to infection, mostly bacterial. It can get infected, show spontaneous symptoms and may rapidly progress. Sometimes, septic arthritis affecting the hip or a neighboring joint can also be a cause of hip joint abscess.
Septic arthritis and hip joint abscess can be seen more in people who have undergone recent surgery or those who have prosthetic devices in the joint. Previous joint injuries, inflammatory joint conditions and problems with hip joint too can increase the chances of septic arthritis and cause hip joint abscess. People having immunodeficiency, autoimmune disorders, other forms of arthritis and diabetes are at greater risk of septic arthritis, which is a common cause of hip joint abscess.
An infection with tuberculosis of the spine or those infections affecting the bones, can sometimes affect the muscles of the legs and the hip joint. Abscess in the thigh, psoas abscess can sometimes be a cause of hip joint abscess.
Other Causes of Hip Joint Abscess
In some cases, hip joint abscess can also be a result of skin and joint infections around nearby areas which can spread to the hip joint. Abscesses at other locations, abscess in the spine or other bones, too can affect the hip joint or inflammation, infections or diseases affecting the muscles, ligaments or tissues around the hip joint.
Risk Factors of Hip Joint Abscess
Certain risk factors can raise the chances of hip joint abscess in some people.
- People with a weak immune system, history of autoimmune disorders, connective tissue disorders, internal abscesses or infections like HIV/AIDS and those on long term steroids or immunosuppressant drugs etc. People having sensitive skin, those with past or present history of skin diseases, skin or subcutaneous abscesses, too can develop hip joint abscess.
- Increased risk of hip joint abscess can be seen in people with hip inflammation or conditions affecting the hip joint, rheumatoid arthritis, previous septic arthritis, hip infections or hip joint abscess. Those who have undergone surgeries of the hip joint, drainage of hip or psoas abscess or those with a prosthetic device near the hip joint are at greater risk of developing hip joint abscess.
- People with skin ulcers, diabetes, poorly controlled blood sugar levels or those with complications of diabetes, etc. can have greater risk of hip joint abscess.
Symptoms of Hip Joint Abscess
The symptoms of hip joint abscess depend on the type and location of the abscess developed.
Skin Abscess in Hip joint Abscess
Certain hip abscesses developed over the skin may present with skin lesion, which may be noticeable with red, itchy and scaly skin over the hip. The symptoms of hip joint abscess present with raised red areas, itchy patches over the skin, which can be painful. The pus filled lesions on the skin around the hip joint are seen in hip joint abscess. The skin under which pus gets collected is soft to touch and can be very painful.
The hip abscess can burst open to drain the pus, which requires to be managed well. The skin lesion of hip abscess can also get hardened or thickened with time but remain painful. The area around the hip joint abscess can be painful and sensitive to touch. Depending on the exact location of the skin abscess, there may also be difficulty in moving the hip, pain when walking, sitting or on touching the area. Hip abscess can also interfere with daily routine activities and make it difficult to perform certain tasks.
Deeper Abscess in Hip Joint Abscess
Some abscesses may develop in the deeper tissues of the hip joint. They may not be visible but present with certain symptoms. The common symptoms of hip joint abscess include
- Hip Pain - Pain in the hip joint is one of the major symptoms of hip joint abscess. Pain may also be felt in the pelvic region, low back and back of thighs. Pain in the hip can also extend down to the legs and toes. Hip joint and the surrounding muscles are severely painful when trying to move and may also be sensitive to touch. Stiffness in the hip is another common symptom of hip joint abscess. Stiffness and pain in hip may develop suddenly and can be felt more during the night or long periods of inactivity.
- Inflammation – Hip joint abscess presents with inflammation, as a sign of inflammation in the hip joint or in the surrounding muscles and tissues. Swelling redness and warmth may be noted around the hip joint.
- Affected Hip Movements – Hip joint abscess causes difficulty in hip movements. The person may find it difficult or painful to move the hips, sit, lie on the hip, bend and lift objects or perform regular functions. Range of motion and movements of the hip are usually affected in hip joint abscess.
Symptoms of hip joint abscess also include signs of infections, fever and chills, which may begin suddenly. In some cases, hip joint abscess can cause nerve impingement or exert pressure on certain important structures. This can cause inflammation to the surrounding tissues or even affect the vascular structures or nerves in the region. Impingement due to hip joint abscess can sometimes cause bursitis, tendinitis, pain in the legs and feet. If nerves get compressed, pain may radiate to the legs, cause burning and tingling sensation or numbness in feet and toes in some cases.
Diagnosis of Hip Joint Abscess
To make a diagnosis of hip joint abscess, it is important to evaluate personal and medical history of the person, clinical examination of the skin lesion or the wound and do the necessary investigations. History can help to reveal underlying medical conditions, skin infections or skin abscesses over the hip joint. It can also help to evaluate hip or other joint problems and the recurrence of hip infections or hip joint abscess. History of diabetes or other disorders can increase the risk of hip joint abscess and must be known.
Clinical examination of cuts, wounds, bites, skin lesions or burns on the skin surface of the hip joint give an idea of the possible causes of hip joint abscess. Any injury, fracture, penetrating injury, presence of foreign body, etc. is evaluated to plan appropriate treatment for hip joint abscess. Clinical examination of the hip joint, its movements and the muscle strength can give an idea about any possible deeper abscess.
Investigations for Hip Joint Abscess
Certain investigations are often needed to confirm the diagnosis of hip joint abscess. These include
- Blood Tests - Blood tests can help to detect the presence of infection in the body or those affecting the hip joint. These help to detect septic arthritis, hip infections or other general infections that can cause hip joint abscess in some people. Specific type of micro-organism can be detected by specialized tests, which aid in diagnosis and treatment of hip joint abscess.
Blood tests may be ordered to rule out other infections, infective arthritis, other types of arthritis, underlying medical conditions, connective tissue or autoimmune disorders affecting the skin, which can cause hip joint abscess. Checking blood sugar levels and assessing diabetes control can aid in proper management of hip joint abscess. Tuberculosis is an infection that can affect the lungs, spine, the bones, etc. and must be evaluated with specific tests.
- Scans – To detect changes in deep hip joint abscess, bone scans and imaging studies may be required. X-rays and CT scans of the hip joint can reveal bony abnormalities, bone injuries, fracture, foreign bodies or diseases affecting the bone. MRI can detect soft tissue injuries, ligament or muscle tears or any abnormality of tissues causing hip joint abscess. Relevant scans of other joints or spine may be considered, if found appropriate.
- Abscess Drainage - Drainage of pus may be considered to confirm diagnosis and support the treatment for hip abscess. It can help to detect infection, the causative organism and any other abnormality causing the hip joint abscess. The drained fluid or pus is sent for laboratory testing and culture analysis.
Hip joint aspiration may be considered as appropriate, as there is an increased risk of infection and inflammation of the joint. A prosthetic joint must also be properly investigated with scans or synovial fluid aspiration to check for site of infection. It can aid in diagnosing joint related conditions and septic arthritis of the hip joint.
Treatment of Hip Joint Abscess
Treatment of hip joint abscess, depends on the cause, location and extent of the hip abscess. To treat a hip joint abscess it is necessary to treat the infection or the condition causing hip joint abscess and manage factors related to hip joint abscess. Skin abscesses may drain or heal on their own, but may require treatment to completely cure the infection.
Some common treatment options for hip joint abscess include:
Hip joint abscess and underlying infections may require antibiotic treatment. Injuries, burns and bites need proper wound care and other necessary treatment. Some cases of hip joint abscess may be resistant to certain medicines, when other anti-biotics may have to be given. Skin abscesses on the hip may be treated with antibiotic creams. Once the causative microorganism is confirmed by blood tests, additional specific treatment or anti-biotics, may be considered.
Other relevant medications depending on the causes and underlying conditions may be given. Diabetes needs appropriate treatment to keep blood sugar levels controlled, which can promote healing of infections and help in recovery of hip joint abscess. Autoimmune disorders or connective tissue diseases must be treated appropriately to control skin infection and hip abscess. Medications may be given to control pain and itching in skin abscess or hip joint. High fever may be managed with fever medicines.
It is important to know that in hip joint abscess, repeated or worsening joint infections, excessive reddening of skin, worsening of skin lesions, eruption of skin abscesses elsewhere in the body, persistent high fever and development of newer symptoms may require immediate medical care. Septic arthritis, with severe hip pain, high fever and sudden onset need immediate medical treatment.
Treatment of Hip Joint Abscess by Draining the Pus
Some cases of hip joint abscess may require drainage of pus as the best treatment option. It usually helps to cure the infection and also prevent the recurrence of hip joint abscess. The best treatment option for hip joint abscess is decided by the treating physician and drainage of pus is performed by the experts. After pus drainage, the area is cleaned and medications may be applied to the area to prevent infections and promote healing.
The hip joint may be immobilized as a part of the treatment of hip joint abscess or after drainage of pus, if appropriate. It helps in immobilization and can aid in recovery of the hip joint. After healing and control of infection, the joint can be mobilized to restore its functions.
Other treatment options of hip joint abscess may be considered if there is a repeat injury, problem with prosthetic device or a deep seated abscess affecting the hip joint.
Physical Therapy for Hip Joint Abscess
Minor abscesses of hip joint may show complete recovery with prompt treatment. However, hip abscesses in which there was hip pain, affected hip functions, or problems with hip joint may require physical therapy. Following necessary treatment of hip joint abscess, it is important to reduce pain, swelling and restore normal function of the hip joint. Physical therapy for hip joint abscess is aimed to provide relief from pain, inflammation and aids in recovery. Physical therapy for hip joint abscess is more useful in arthritis, septic arthritis, hip stiffness and hip pain. Therapeutic exercises can help to maintain flexibility of the joint, strengthen the muscles and improvement range of motion.
Complications of Hip Joint Abscess
Prompt treatment of hip joint abscess usually helps to treat the infection and condition with complete recovery. However, in some cases, hip joint abscess can spread to nearby areas or to deeper tissues, resulting in certain complications. Hip joint abscess can respond well to immediate treatment, however, if treatment is delayed, it can result in long term hip pain, stiffness of hip joint and joint destruction in some cases.
Prevention of Hip Joint Abscess
Skin abscess can be prevented by maintaining good hygiene and hand washing habits to prevent skin infections. It is also important to note that any skin infection, boils or abscesses should be promptly treated in an appropriate way. Injury, wounds, cuts, burns or bites around the hip must be properly cleaned, treated well. Proper wound care is important to prevent infections and hip abscess. People with joint problems, previous hip infections or septic arthritis can maintain flexibility, strength and blood circulation with regular exercise.