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Prosthetic Joint Infection
Posted: Aug 7 2020 #(C101559)
B

Postoperative Prosthetic Joint Infection in a 64M

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HPI

This is a 64M who presents 5 weeks status post L primary TKA performed by a local physician. He presented with a few days of drainage from his left knee which he reported as "white pus". He otherwise noted increasing knee pain over the past few days, swelling, and inability to effectively ambulate yesterday. He presented to the ED at which point Ortho On-call was consulted.

PMH

Morbid obesity (BMI 42), COPD, T2DM (controlled), HTN, Hyperparathyroidism, Rhematoid arthritis, previous MRSA and VRE infections (not involving the LLE)

PE

AF/VSS, A&O MSK - LLE - focused exam of L knee demonstrates erythema over a healed midline incision with copious persistent drainage from sinus at the distal aspect of the incision, persistent serous drainage, intra-articular effusion as evidence by distended suprapatellar pouch, moderate global TTP about the left knee, ROM limited form 10- 75 degrees 2/2 pain, otherwise ligamentously stable and NVID with peri-incisional paresthesias, W/WP foot Labs: Serum labs: CBC 10,000, ESR 30, CRP 6.0

Poll
1 of 9
In addition to the plain film radiographs of the knee shown, would you obtain any additional imaging to guide management?
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P: 118787
Given the presence of a draining sinus, would you aspirate the knee in order to guide management?
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P: 118788
How would you manage this patient?
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P: 118780
If you choose Operative management, what type of surgery would you perform?
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P: 118781
If you choose Revision arthroplasty, what type would you perform?
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P: 118782
If you choose Two-stage revision, what type of spacer would you use?
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P: 118783
If you choose Two-stage revision, when would you plan on second stage re-implantation?
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P: 118784
If you choose Two-stage revision, would you obtain any additional work-up prior to second stage re-implantation?
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P: 118785
If you choose Two-stage revision, would you use antibiotic cement for the second stage re-implantation?
Other
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P: 118786
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