As a result of increasing life expectancies, continuing physical careers, lifestyles into later life and rising obesity levels, the number of younger patients presenting with osteoarthritis (OA) of the knee is increasing. When conservative management options have been exhausted, the challenge for the orthopedic surgeon is to offer a procedure that will relieve symptoms and allow a return to a high level of function but not compromise future surgery that may be required as disease progresses or prostheses fail and require revision. We discuss the options available to this group of patients and the relative benefits and potential negative points of each. Total knee replacement (TKR) in the young patient is associated with high risk of early failure and the need for future revision surgery. After TKR, most surgeons advise limitation of sporting activities. If osteoarthritis is limited to only one compartment in the knee there may be surgical options other than TKR. Osteotomy above or below the knee may be considered and works by redirecting the load passing through the joint into the relatively unaffected compartment. A unicompartmental knee replacement (UKR) or patella-femoral joint (PFJ) replacement only replaces the articular surfaces in the affected compartment, leaving the unaffected compartments untouched with better preservation of the soft tissues. Which of these options is best for a particular patient depends upon the patient's symptoms, precise pathology, lifestyle, and expectations.
Pasteurella multocidais a small Gram-negative bacterium comprising part of the normal gastrointestinal and nasopharyngeal flora of domestic pets, such as dogs and cats. It rarely causes infection in humans. Previous reports ofP multocidacausing prosthetic joint infection have described either haematogenous spread of infection from a distant site through a scratch or bite, or reactivation of infection from a previous injury. We report a case of acute total knee arthroplasty joint infection becoming acutely infected byP multocida. We postulate that the mechanism of infection was direct contamination of the wound as a consequence of the patient being licked by his pet dog. We discuss the potential role played by thromboprophylaxis as a factor contributing to prolonged wound leak.
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