We present a case of a 60-year-old male with poorly controlled type 2 Diabetes that had recurrent prosthetic knee infection that besides antibiotic or surgical treatment was difficult to treat. On the latest revision, he presented with an infection of the knee spacer with severe stiffness impairing knee flexion. In the debridement phase, we noticed a nidus of purulent tissue on the quadriceps tendon hidden inside an apparently normal peritendon. This case highlights several management details to avoid recurrent catastrophic prosthetic knee infection recurrence such as: the importance of perioperative management of comorbid diseases such as hyperglycaemia and poorly controlled diabetes that are a well-defined evidence-based risk factor for prosthetic joint infection and also the importance of adequate debridement as a balanced surgical gesture between excising too little or too much not to damage the soft tissue envelope.
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