This is a 56-year-old female who presented as an outside transfer for management of a suspected right prosthetic knee infection with sepsis. ER provider reportedly aspirated "pus" in ED. Ort hopaedic provider did not feel comfortable managing her. She was placed on broad-spectrum IV ABX prior to transfer. She reports 2 weeks of increasing pain to the right knee, prior to which the knee was functional and painless. She underwent an uncomplicated primary TKA 2 years prior and had recovered completely. She additionally notes fevers, chills, and nausea which developed over the past 48 hours.
Breast cancer (undergoing chemotherapy), lupus with nephritis
Febrile, tachycardic but otherwise HDS on arrival (reportedly hypotensive and tachycardic prior to transfer), A&O
RLE - well-healed midline incision from prior TKA, large joint effusion as evidence by ballotable patella and distended suprapatellar pouch, no clinical deformity, no overlying erythema thought knee is warm. Tenderness globally about the knee with motion limited from 15-60 degrees of flexion 2/2 pain and stiffness. Grossly NVID w/ prior paresthesia about the distribution of the infrapatellar branch of the saphenous nerve.
Serum CBC 12,000, ESR 61, CRP 14
Synovial WBC 263,000, gram (+) cocci in clusters, MSSA (+) blood culture