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Prosthetic Joint Infection
Posted: Aug 7 2020 #(C101558)
B

Prosthetic Joint Infection in a 56F

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HPI

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.

PMH

Breast cancer (undergoing chemotherapy), lupus with nephritis

PE

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. Labs: Serum CBC 12,000, ESR 61, CRP 14 Synovial WBC 263,000, gram (+) cocci in clusters, MSSA (+) blood culture

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Would you obtain additional imaging to guide management?
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P: 118764
Would you use the Musculoskeletal Infection Society (MSIS) criteria to guide management?
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P: 118779
How would you manage the patient?
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P: 118762
If you choose Operative management, assuming the patient arrived at 8 pm and had eaten a full meal 3 hours prior, when would you perform surgery?
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P: 118763
If you choose Operative management, what surgery would you perform?
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P: 118765
If you choose Debridement and irrigation with poly exchange, what type of solution(s) would you irrigate with?
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P: 118769
If you choose Debridement and irrigation with poly exchange, how would you manage the polyethylene patellar button?
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P: 118768
If you choose Debridement and irrigation with poly exchange, would you supplement with intra-articular antibiotics?
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P: 118766
If you choose Debridement and irrigation with poly exchange, how long would you manage this patient on postoperative IV antibiotics?
Other
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P: 118767
If you choose Debridement and irrigation with poly exchange, how would you determine the success of the treatment?
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P: 118770
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