Total joint replacement for neglected posterior knee dislocation following septic arthritis after arthroscopy

Abstract

This report presents theŞrst case of a knee dislocation following septic arthritis after arthroscopy. A 65year-old woman had an arthroscopy with irrigation and debridement (I&D) of the joint and microfracturefor the chondral lesions. She had complaints of postarthroscopic infection but non-steroidal anti-inflammatory medication and local ice compression was recommended. She revisited her physician twice and atthe last visit she had a large purulent effusion in her knee. The gram stain of the jointfluid aspiratedemonstrated gram-positive cocci and the cultures grew methicilline-sensitive Staphylococcus aureus. Sheunderwent arthroscopic assisted I&D and received intravenous antibiotics. I&D was repeated after twoweeks. Intravenous antibiotherapy was continued for one more week and was changed to oral antibiotherapy for six weeks. At the third month visit's physical examination, a deformity at the knee wasnoticed and was referred to us for further treatment. A posterior knee dislocation with no neurovasculardeŞcit was detected. The patient had a history of knee sprain but did not seek medical advice immediately.The blood samples showed no abnormality. The patient underwent a surgery with a cemented hingedrevision total knee prosthesis following the exclusion of the active knee joint infection. Intraoperativefrozen sections were also taken to exclude the active infection. The patient's knee is pain-free with fullrange of motion after 3 years. The objective of this report was to highlight the importance of early diagnosis,prompt appropriate treatment of septic arthritis following arthroscopy and the awareness of the kneedislocation as a rare dreadful complication of postarthroscopic infection particularly in elderly patients.