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Prosthetic Joint Infection
Posted: Aug 10 2020 #(C101563)
B

Acute Prosthetic Joint Infection in a 58M

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HPI

This is a 58-year-old male who underwent R TKA for OA 2 weeks ago. Prior to surgery he had medial and anterior knee pain that limited his ability to ambulate to 5-10 blocks. He has a BMI of 29.8, and prior to surgery he had varus alignment with ROM 10-125 degrees. His TKA went without complication. He returns to clinic now with drainage from his surgical incision.

PMH

HTN, BPH

PE

Febrile, VS are otherwise unremarkable RLE - midline surgical incision from prior TKA is incompletely healed with central area of wound dehiscence and purulent drainage. Knee largely erythematous with large effusion and warm to touch. ROM limited to 10-60 degrees secondary to pain. NVID. Labs: Serum CRP 14 mg/dL, ESR 85 mm/hr Synovial WBC 85,000 WBC, 90% PMNs, coag negative Staph

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Would you obtain additional imaging to guide management?
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P: 118919
Would you use the Musculoskeletal Infection Society (MSIS) criteria to guide management?
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P: 118920
How would you manage the patient?
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P: 118921
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: 118922
If you choose Operative management, what surgery would you perform?
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P: 118923
If you choose Debridement and irrigation with poly exchange, what type of solution(s) would you irrigate with?
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P: 118924
If you choose Debridement and irrigation with poly exchange, how would you manage the polyethylene patellar button?
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P: 118925
If you choose Debridement and irrigation with poly exchange, would you supplement with intra-articular antibiotics?
Other
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P: 118926
If you choose Debridement and irrigation with poly exchange, how long would you manage this patient on postoperative IV antibiotics?
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P: 118927
If you choose Debridement and irrigation with poly exchange, how would you determine the success of the treatment?
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P: 118928
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