Patient Profile
- Demographics: A 66-year-old male with a history of right total knee replacement (TKR) performed 3 years prior.
- Chief Complaint: Persistent on-and-off discharging sinus from the right knee, accompanied by pain and impaired gait.
- Past Medical History: Previously treated for the discharging sinus with antibiotics. No history of diabetes or hypertension.
- Inflammatory Markers: Elevated C-reactive protein (CRP) at 80 mg/L, erythrocyte sedimentation rate (ESR) at 112 mm/hr, and total leukocyte count (TLC) at 9800 cells/µL, suggestive of an active infection.
Microbiological Evaluation
- Microscopy and Sensitivity: Microscopic examination and sensitivity testing were conducted on a sample collected from the infected TKR site.
- Pathogen Identification: Staphylococcus aureus was isolated as the causative organism.
- Antibiotic Susceptibility: The isolated S. aureus strain demonstrated sensitivity to a range of antibiotics, including amoxicillin/clavulanic acid, cefuroxime, cefazolin, ceftaroline, gentamicin, linezolid, tetracycline, tigecycline, and vancomycin. Resistance was noted to erythromycin/azithromycin, clindamycin, and sulfamethoxazole/trimethoprim.
Surgical Intervention
- Revision TKR: The patient underwent a revision TKR procedure to address the infected prosthesis.
- Procedure Details: Intraoperative images (5-8) document the key steps of the surgical intervention, including the explantation of the infected prosthesis and the subsequent implantation of the new prosthesis.
Post-operative Care
- Antibiotic Therapy: Targeted antibiotic therapy was initiated based on the sensitivity profile of the isolated S. aureus to mitigate the risk of persistent or recurrent infection.
- Clinical Follow-up: Regular follow-up appointments were scheduled to monitor the patient’s clinical progress, assess wound healing, and ensure the successful integration of the new prosthesis.
Clinical Considerations
This case underscores the complexity of managing prosthetic joint infections (PJIs), even in cases where the initial arthroplasty was performed several years prior. PJIs pose significant clinical challenges, often necessitating a multidisciplinary approach to optimize patient outcomes. Key elements of successful PJI management include:
- Comprehensive Surgical Debridement: Thorough surgical debridement of the infected tissues and removal of the infected prosthesis are paramount.
- Targeted Antibiotic Therapy: Selection of antibiotics should be guided by the specific pathogen(s) identified and their corresponding antibiotic susceptibility profiles.
- Prosthesis Revision: Revision arthroplasty with a new prosthesis is often necessary to restore joint function and stability.
- Close Clinical Monitoring: Regular clinical and radiological follow-up is essential to monitor for signs of recurrent infection and to ensure proper implant integration and functional recovery.
Disclaimer: The information provided herein is intended for educational purposes only and should not be construed as medical advice. Individual treatment plans should be determined in consultation with a qualified healthcare professional, taking into account the patient’s specific clinical circumstances.