DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20214970

Surgical management of septic knee arthritis with open arthrotomy and debridement-a case report

Neetin Pralhad Mahajan, Kartik Prashant Pande, Ravi Rameshbhai Dadhaniya, Pritam Talukder

Abstract


Septic arthritis is an inflammatory destruction of the native joint following inoculation of pathogen. Most common organisms causing septic arthritis are Staphylococcus and Streptococcus. Large joints are commonly involved with hip and knee joint accounting for approximately 60% of the total cases. Diagnosis is usually straightforward with the patient presenting with obvious local signs and symptoms along with toxic constitutional symptoms owing to the aggressive nature of the disease. Medical management in form of intra-venous antibiotics forms the mainstay of treatment but it is often required for a prompt surgical intervention in order to provide acute relief from symptom and also to decrease the disease load so as to save the joint from irreversible damage. We have a 63-year-old male patient came presented to us with a right knee swelling and tenderness of 3 weeks duration with restricted ROM with severe toxic constitutional symptoms of 1 week duration. Patient was planned for open arthrotomy and debridement and drainage of the pus and was started on an empirical therapy of injection piperacillin and tazobactam combination for 3 weeks. Immediate relief from symptoms following arthrotomy with good range of motion at 4 weeks post-surgery. As is clear from our case, an early diagnosis of septic arthritis and starting of appropriate antibiotics along with appropriately aggressive surgical interventions in the form of open debridement is the key for treatment of septic arthritis in order to save the joint from irreversible inflammatory damage. Surgical intervention not only gives immediate symptomatic relief but also decreases the load over antibiotics and increases local blood supply subsequently helping in better healing.

 


Keywords


Septic arthritis, Arthrotomy, Debridement, Empirical therapy

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References


Gupta MN, Sturrock RD, Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford). 2001;40(1):24-30.

Kaandorp CJ, Dinant HJ, Van de Laar MA, Moens HJ, Prins AP, Dijkmans BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997;56(8):470-5.

Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al. Polyarticular septic arthritis. Medicine (Baltimore). 1993;72(5):296-310.

Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. Lancet. 2010;375(9717):846-55.

Hultgren OH, Svensson L, Tarkowski A. Critical role of signalling through IL-1 receptor for development of arthritis and sepsis during Staphylococcus aureus infection. J Immunol. 2002;168:5207-12.

Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann Rheum Dis. 1999;58(4):214-9.

Peacock EE Jr. Some biochemical and biophysical aspects of joint stiffness: role of collagen synthesis as opposed to altered molecular bonding. Ann Surg. 1966;164:1-12.

Eralp L, Kocaoglu M, Tuncay I, Bilen FE, Samir SE. Knee arthrodesis using a unilateral external fixator for the treatment of infectious sequelae [in Turkish]. Acta Orthop Traumatol Turn. 2008;42:84-9.