Pus-Like Synovial Fluid in Native Hips with Avascular Necrosis During Total Hip Arthroplasty

CASE: We report the cases of 2 male patients (aged 66 and 48) with hip avascular necrosis (AVN) and no history of hip infection, who presented pus-like synovial fluid during primary total hip arthroplasty (THA). Intraoperative C-reactive protein was normal, and cultures remained negative. Both underwent uncomplicated THA with favorable outcomes at 1-year follow-up. CONCLUSION: Pus-like joint fluid can occur in AVN without infection. Negative cultures in both cases suggest this finding is related to AVN pathology rather than septic arthritis.