Rice Body Formation in an Enterococcus faecalis-Infected Total Hip Arthroplasty Causing Sciatic Nerve Compression

TL;DR

A 73-year-old woman with a hip replacement developed a rare rice body cyst caused by an infection, requiring surgery and antibiotics for recovery.

Contribution

This is the first report of rice body cyst formation in an infected total hip arthroplasty.

Findings

A rice body cyst was discovered during surgery in a patient with a periprosthetic joint infection.

Complete excision of the cyst and antibiotic treatment led to successful recovery.

Histopathology confirmed the presence of rice bodies without malignancy.

Abstract

We present a case of a 73-year-old lady with a previous uncemented left total hip arthroplasty (THA) three years prior to her current presentation. She presented with an enlarging ‘granulomatous'-looking swelling at the distal aspect of her THA scar for three months that was associated with shooting pain from the posterior aspect of her hip radiating down to her foot. The culture and sensitivity of her hip aspirate revealed the growth of Enterococcus faecalis. She underwent revision surgery utilising a ‘well-fixed’ Exeter custom-made articulating spacer (CUMARS). Intra-operatively, a large encapsulated cyst containing rice bodies was discovered deep within the fascia lata. A complete excision of this cyst was performed. Post-operatively, the patient was treated with two weeks of IV antibiotics and ten weeks of oral antibiotics. Histopathological examination confirmed the presence of rice bodies, with no malignancy seen. We aim to highlight the possibility of rice body cyst formation in the setting of a periprosthetic joint infection (PJI) around a THA and the importance of early treatment in such cases. This is the first published report of a rice body cyst formation in an infected THA.

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