Hip and pelvic pain during pregnancy or after delivery is a common problem in young females, and in most cases this problem has a self-limiting course. The patient described in this case suffered from severe hip pain after childbirth. MR imaging study was performed and it showed arthritis of bilateral hip joints and osteomyelitis of femoral heads with an abscess in the surrounding muscle. Infection, such as septic arthritis or osteomyelitis, is an extremely rare cause of peripartum joint pain. The patient's clinical symptoms and laboratory findings improved with antibiotic therapy. However, limitation of motion of the bilateral hip joints persisted although the patient continued rehabilitative therapy for 15 months, and the patient had to undergo bilateral total hip replacement. Hereby, we present a case of severe osteomyelitis and pyogenic arthritis of bilateral femoral heads and hip joints after delivery, which eventually required bilateral total hip replacement.

Citations

Citations to this article as recorded by  

• Bilateral Erosive Septic Hip Arthritis Following Pregnancy
  Emily A. Treu, Christopher E. Pelt, Michael J. Archibeck
  Arthroplasty Today.2022; 16: 192.     CrossRef
• Incremental Value of Three-Phase Bone Scintigraphy and Single-Photon Emission Computed Tomography–Computed Tomography in a Case of Postpartum PUO in the Wake of The Antibiotic-Resistance Era
  Pramukh Kulkarni, Indirani M. Elangoven, A Jaykanth, Shelley Simon
  Indian Journal of Nuclear Medicine.2021; 36(1): 62.     CrossRef

Objective: To investigate a biomechanism of pelvic pain in pregnancy by use of motion analyzer.

Method: Ten pregnant women in the early third trimester and 10 healthy women as control were enrolled. A gait analysis by a Vicon 370 motion analyzer system was performed to investigate the dynamic lumbo-pelvic motion of pregnancy in biomechanical aspects.

Results: The mean maximal surface lordotic angle of pregnant women was 24.42⁑3.98 degrees, the mean minimal surface lordotic angle 20.64⁑4.27 degrees, and the mean maximal surface lordotic angle of controls was 21.61⁑2.43 degrees, the mean minimal surface lordotic angle 18.38⁑2.29 degrees (p＞0.05). The mean maximal anterior pelvic tilt of pregnant women was 21.11⁑5.91 degrees, and the mean maximal anterior pelvic tilt of controls was 15.28⁑4.94 degrees (p＜0.05).

Conclusion: The angle of lumbar lordosis was within normal ranges but the anterior pelvic tilt was increased significantly in pregnancy. This can place mechanical stress on lumbo-pelvic region. This dynamic sagittal imbalance of the spine may be a considerable cause for low back and pelvic pain in pregnancy as indicated by the results of this study.

Objective: This study was designed to evaluate the demand for lumbosacral corset and to get a base line data for rehabilitation approach, management trends, demand for education of back pain, and incidence of back pain during pregnancy in Korean population.

Method: One hundred and fifty two postpartum women were included in this study. Each subject's demographic data, gynecologic data, back pain associated factors, and neonatal factors were collected.

Results: The incidence of back pain during pregnancy was 81%. Average age of back pain group and pain⁣free group were 29.8⁑4.51 and 26.8⁑5.50, respectively. Average age of back pain group was significantly older than pain⁣free group. Patients with previous back pain suffered from back pain during pregnancy more frequently than the patients without previous back pain. Sites of back pain were lumbar area (49.2%), midback area (29.5%), and sacroiliac area (21.3%).

Conclusion: Correlation factors of back pain during pregnancy were maternal age, previous history of back pain, and history of back pain during menstruation. Long term follow up study for back pain after delivery and early evaluation of back pain during antenatal care are recommended.

Objective: To investigate the frequency, nature and risk factors of musculoskeletal problems in pregnancy.

Method: We obtained the information through a questionnaire and physical examination of full-term (gestational age over 38 weeks) pregnant women. Prevalence, onset time, severity and risk factors of musculoskeletal problems were analyzed.

Results: Among the 70 pregnant women, 37 women (53%) complained of low back pain which was the most common musculoskeletal problem in pregnancy. Other problems were hand symptoms (31%), lower extremity joint pain (31%), leg cramp (29%), chest pain, shoulder pain and neck pain. Previous history of low back pain was significantly correlated with the occurrence of low back pain in pregnancy. Weight gain during pregnancy and amount of time of housework during pregnancy were significantly correlated with carpal tunnel syndrome. Pregnant women suffering from leg cramp were significantly old in age.

Conclusion: Prevalence of musculoskeletal problems during pregnancy was relatively high and several risk factors were related with occurrence of those problems. So, prophylactic risk factor control would be necessary to reduce musculoskeletal problems during pregnancy.

Objective: To study the effect of pregnancy on knee joint contracture in the rat, because the laxity of peripheral joint increases during pregnacy.

Method: We evaluated the difference of contracture between the pregnant and non-pregnant female rats after 3 week of knee immobilization using a wire. The femorotibial angle at immobilization status was 30^o. After immobilization, the femorotibial angle were measured using X-ray after removal of wire at 50 g and 100 g weighted state on the tibia. To study the change of fibroblast in immobilized knee joint ligament, immunohistochemical staining for actin was performed using α-smooth muscle actin antibody (DAKO, Denmark).

Results: The femorotibial angles were 116.7⁑9.2^o and 97.3⁑18.0^o after wire removal, in the immobilized pregnant and nonpregnant rats respectively. The femorotibial angles at 50 g and 100 g weighted state were 136.8⁑7.2^o and 144.7⁑3.8^o, respectively in the immobilized pregnant rats and 129.4⁑12.7^o and 136.3⁑8.9^o in the immobilized non-pregnant rats. The angles of pregnant group were significantly larger than those of non-pregnant group (p＜0.05). In immobilized pregnant and non-pregnant rats, the α-smooth muscle actin was moderately expressed in fibroblast of anterior and posterior cruciate ligaments of the knee by immunohistochemistry, while there was no expression of α-smooth muscle actin in fibroblast of the ligaments in the non-immobilized knee.

Conclusion: Joint contracture develops to a lesser degree in pregnant rats than in non-pregnant rats and α-smooth muscle actin is expressed in fibroblast of contractured knee ligaments.

임신중 요통은 비교적 증상이 경미하고, 하흉추부·요추부·천장관절부에 흔히 생기는 것으로 알려져 있다. 대부분의 경우는 그 증상이 자연소멸되지만 연구자들은 약 27%의 산모에서는 출산 6개월후에도 요통을 호소하는 것으로 보고되어 있다. 임신중 요통 발생에 관계되는 인자에 대해서는 아직 정확히 밝혀진 바는 없지만 그동안의 연구들에서는 신장과 체중, 임신전 비만정도, 임신중 체중의 증가, 태아 체중, 임신중 활동정도 및 직업 등은 유의한 위험인자가 아니라는 점에 대해서는 대체적으로 동의하고 있으며, 산모의 연령, 다산 및 요통의 과거력 등에 대해서는 아직 의견의 일치를 보지 못하고 있다. 또한 그 원인에 대해서는 여러 가지 의견들이 있지만 대체적으로, 신체역동학적 으로 나타나는 요추부의 과도한 하중 및 혈중 릴랙신이 증가하여 생기는 천장관절의 기능 부전이 주 요인으로 알려져 있다. 따라서 연자들은 한국인에서 임신중 요통의 분포 및 양상이 외국의 보고와 어떻게 다른 지, 통증의 양상의 표현은 어떤지, 임산부의 체형이 요통의 발생과 관련이 있는 지, 요추 후만의 증가가 요통의 발병에 중요한 역할을 하는 지를 알아보고자 1997년 3월부터 9월까지 산전관리를 위하여 성모병원 산부인과를 방문한 202명의 산모를 대상으로 본 연구를 시행하여 다음과 같은 결과를 얻었다.

한국인 산모에서 임신기간에 관계없이 요통의 유병률, 통증이 나타나는 시기 및 통증 부위는 다른 나라 여성들과 유사한 양상을 보였다. 산모의 연령, 출산 횟수, 신장 및 체중 등은 산모의 요통 발생에 큰 영향을 미치지 않는 것으로 보이며, 반면에 요통의 과거력은 산모의 요통을 예측하는 데 도움을 줄 것이라고 판단된다. 또한 요추 후만의 정도는 산모의 요통과 밀접한 관계가 있음을 알 수 있었다.