A Patient with Fatal Necrotizing Fasciitis following the Use of Intra-Articular Sodium Hyaluronate Injections: A Case Report

Abstract

Introduction. Osteoarthritis, a degenerative joint disease, is a key cause of disability around the world and an ever-growing public health concern. Intra-articular hyaluronic acid viscosupplementation is used as a conservative option for osteoarthritis knee pain relief (McArthur et al., 2012; Hootman and Helmick, 2006; Huang el al., 2011). In general, the literature has shown an excellent safety profile for this treatment modality (McArthur et al., 2012; Clegg et al., 2013; Hammesfahr et al., 2003; Neustadt et al., 2005; Cohen et al., 2008; Neustadt, 2003; Jüni et al., 2007; Peterson and Hodler, 2011). Case Presentation. In this report, we describe a case of a woman who had received multiple sodium hyaluronate injections and developed severe necrotizing fasciitis near the injection site. Conclusion. We recommend that clear guidelines for clean technique be put in place for use with sodium hyaluronate injections and consideration of full sterile technique in immunosuppressed patients.

Management of knee osteoarthritis. Current status and future trends

“…Side effects are mild, but complications may arise from the approach of delivery as soft tissue components of the knee are often harmed, resulting in additional pain experience. A possible solution could be the application of imaging guidance to improve the accuracy of injection (Virupannavar and Guggenheim, ).…”

A Fatal Sepsis Caused by Hyaluronate Knee Injection: How Much the Medical History and the Informed Consent Might Be Important?

“…Septic arthritis is a rare but potentially fatal [8, 23–25] severe complication after an intra-articular injection. Although injective practice is conducted in sterile ways, the incidence of joint infection is estimated to be 0,01%–0,072% [19].…”

“…Then, it should be noted that there are no international common agreements about guidelines for implementation of clean and aseptic technique [8]. …”

“…Viscosupplementation with intra-articular hyaluronic acid was approved as a conservative option for OA in 1997 by FDA (Food and Drug Administration) [7, 8]. Important benefits for this kind of treatment have been proven in the last years: a recent Cochrane review found overall benefits of viscosupplementation in comparison to placebo for pain, function, and patient global assessment scores [9].…”

Severe Acute Localized Reactions Following Intra-Articular Hyaluronic Acid Injections in Knee Osteoarthritis

“…The safety profile of HA is well established, 1 but some concerns have been raised regarding reactions that follow in a limited number of HA patients. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] These symptoms are generally manifested within several hours to 72 hours after the HA injection, with some occurring 5 to 6 days later. [2][3][4]6,8,9,[12][13][14][17][18][19] Patients may present with severe pain, hot and/or swollen joint, effusion, and loss of function.…”