A Rare Case of Septic Knee Arthritis Caused by Clostridium perfringens in a Patient With Colostomy

Introduction. High tibial osteotomy (HTO) is a frequent and effective treatment for unicompartmental gonarthritis. Only a few articles are focused on the treatment of infected nonunion. Patient and Method. A 50-year-old obese patient was operated on by medial opening-wedge HTO. She developed a painful nonunion treated by hardware removal, allograft, and plate fixation. However, the nonunion persisted. 2 years later, cellulitis appeared with an abscess adjacent to the HTO plate. Despite surgical debridement and antibiotics, septic knee arthritis occurred. In a situation of infected nonunion and septic arthritis with chondrolysis, she was scheduled for a 2-stage total knee replacement (TKR). The infected tibial articular block was first resected and replaced by a cement spacer. After a short interval, the TKR was implanted. After 2 years, the patient walked pain-free with good knee function. Discussion. In the literature, different efficient treatments exist for infected nonunion after HTO, but comprehensive studies are missing for a consensus treatment. Current data are mostly based on case reports, since this pathology is quite rare. Conclusion. In a difficult situation of infected nonunion with septic knee arthritis, we performed a 2-stage knee prosthesis implantation. This led to an early mobilization and fast recovery.

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Treatment of Septic Knee Arthritis: Comparison of Arthroscopic Debridement Alone or Combined With Continuous Closed Irrigation-Suction System

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3181ec4734 ◽

2011 ◽

Vol 71 (2) ◽

pp. 454-459 ◽

Cited By ~ 18

Author(s):

Chun-Lin Kuo ◽

Jen-Huei Chang ◽

Chia-Chun Wu ◽

Pei-Hung Shen ◽

Chih-Chien Wang ◽

...

Keyword(s):

Arthroscopic Debridement ◽

Knee Arthritis ◽

Suction System ◽

Septic Knee Arthritis

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Genomic Characterization of a New Biofilm-Forming and Adhesive ST398 Human-Adapted MSSA Lineage Causing Septic Knee Arthritis Following Surgical Reconstruction

Microorganisms ◽

10.3390/microorganisms9020305 ◽

2021 ◽

Vol 9 (2) ◽

pp. 305

Author(s):

Viviana Cafiso ◽

Flavia Lo Verde ◽

Alessandra Zega ◽

Giuseppe Pigola ◽

Roberto Rostagno ◽

...

Keyword(s):

Surgical Reconstruction ◽

Adhesive Properties ◽

Knee Arthritis ◽

Single Nucleotide ◽

Great Ability ◽

Joint Infections ◽

Genomic Adaptation ◽

Genomic Characterization ◽

Septic Knee Arthritis

Methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen commonly found in bone and joint infections, including septic arthritis. S. aureus virulence and the frailty of affected patients can cause several complications; a prompt and specific antibiotic treatment can positively affect the outcome of patients. We carried out an in-depth genomic characterization by Illumina whole genome sequencing and bioinformatics of two biofilm-producing M1 and M2 ST398 MSSA causing septic knee arthritis not-responding to antimicrobial therapy. The strains were characterized for antibiotic resistance, biofilm and adhesive properties as well as genomics, single nucleotide polymorphism phylogeny, resistomics and virulomics. Our results showed that M1 and M2 MSSA were ST398-t1451-agrI-Cap5, susceptible to cefoxitin and resistant to erythromycin and clindamycin, traits consistent with the lack of the SCCmec-locus and the presence of the sole blaZ and ermT. Furthermore, M1 and M2 were biofilm-producing and largely potentially adhesive strains, as indicated by the adhesion gene profile. Our data characterized a new human-adapted ST398 MSSA lineage, representing a “fusion” between the human-animal independent ST398 and the Livestock Associated (LA) ST398 lineages, forming biofilm and genomically predicted high adhesive, characterized by different genomic adaptation conferring a great ability to adhere to the host’s extracellular matrix causing septic knee arthritis.

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Case report: Management of septic knee arthritis with Pseudomonas aeruginosa by arthroscopic debridement and lavage with diluted povidone iodine

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.106262 ◽

2021 ◽

pp. 106262

Author(s):

Salah Tewfik Daradkeh ◽

Mohammad Jamal Abunasser ◽

Yazan Tawfiq Daradkeh ◽

Mohammad Suleiman Olimat ◽

Waleed F. Dabbas ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Case Report ◽

Povidone Iodine ◽

Arthroscopic Debridement ◽

Knee Arthritis ◽

Septic Knee Arthritis

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Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: a systematic review

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.200129 ◽

2020 ◽

pp. 1-7

Author(s):

Cornelia M. Donders ◽

Anne J. Spaans ◽

Johannes H. J. M. Bessems ◽

Christiaan J. A. van Bergen

Keyword(s):

Systematic Review ◽

Septic Arthritis ◽

Meta Analysis ◽

Treatment Strategies ◽

Needle Aspiration ◽

Scientific Quality ◽

Knee Arthritis ◽

Level Of Evidence ◽

Septic Knee Arthritis

Purpose Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children. Methods The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO). Results Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. Conclusion Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae. Level of evidence IV

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