Knee septic arthritis caused by α-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report

Balato, Giovanni; Ascione, Tiziana; Iorio, Paolino; Franco, Cristiano De; Matteo, Vincenzo de; D’Addona, Alessio; Tammaro, Nicola; Pellegrino, A.

doi:10.1186/s12879-019-4556-4

Cited by 6 publications

(3 citation statements)

References 38 publications

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“…Arthroplasty is an orthopedic surgical procedure in which a musculoskeletal joint damaged due to trauma or arthritis is replaced to relieve pain and restore the joint's function. The incidence rate of postoperative knee joint replacement is meager and is approximately 0.01–3.4% [ 6 ]. The onset of PJI is divided into three stages: early, delayed, or late, which initiate at 3 months, 12 months, and > 12–24 months after surgery, respectively.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic knee joint infection caused by α-hemolytic Streptococcus species: a case report

Mardani¹,

Mohammadshahi²,

Teimourpour³

2023

J Med Case Reports

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Background Knee arthroplasty is an orthopedic surgical procedure in which a damaged joint is replaced with an artificial one. It is estimated that 1–2% of knee arthroplasties will encounter infection over their lifetime. Although α-hemolytic Streptococcus species play an important role in prosthetic joint infection, they are less common than staphylococcal species. Case presentation In this report, a 50-year-old Iranian woman was diagnosed with prosthetic knee joint infection based on clinical, radiological, and laboratory findings. She was diabetic and had undergone a left total knee arthroplasty, which, 18 months after the surgery, presented pain, erythema, and edema in that knee. The primary culture of knee aspirate was positive for α-hemolytic Streptococcus species, but following antibiotic medication, culture was negative. The primary antibiotic regime was vancomycin and meropenem, which was changed to cefepime for the management of the infection based on the results of antimicrobial susceptibility testing. Conclusions This report indicated the clinical presentation and management of the patient with prosthetic joint infection in which the patient recovered without any severe complications or surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Prosthetic knee joint infection caused by α-hemolytic Streptococcus species: a case report

Mardani¹,

Mohammadshahi²,

Teimourpour³

2023

J Med Case Reports

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“…14 Despite this, at present, no clear guidelines are reported in the literature, and the analysis conducted in this systematic review showed that several surgical options had been variably applied in patients with different stages of septic knee arthritis according to the Gächter classification system. [15][16][17][18] Some interesting considerations can be made based on our analysis.…”

Section: Discussionmentioning

confidence: 99%

The eradication rate of infection in septic knee arthritis according to the Gächter Classification: a systematic review

et al. 2022

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Introduction Knee septic arthritis rapidly damages the knee joint. Gächter described a classification of joint infections based on arthroscopic findings: an arthroscopic staging of the common disease has prognostic and therapeutic consequences. The aim of this systematic review was to analyze the application of the Gächter classification system to knee septic arthritis, evaluating prognostic and therapeutic implications of this classification. Materials and Methods A comprehensive electronic search of the literature was performed. The following search terms were used: (Arthroscopy* OR Arthrotom* OR Aspiration) AND Knee AND Septic AND Arthritis. The study reported the Gächter classification in septic knee arthritis and the eradication rate according to the type. The primary endpoint is the eradication rate of septic knee arthritis according to the Gächter sort. Secondary endpoints are surgical procedures according to Gächter classification and the rate of re-operations. Results Seven studies were included. The overall eradication rate of knee septic arthritis ranged from 90% to 100%: 95%-100% Gächter I; 97%-100% Gächter II; 67%-100% Gächter III; 50%-100% Gächter IV. Surgical treatments for knee septic arthritis included arthroscopic irrigation alone, articular irrigation, and debridement in knee arthroscopy or knee arthrotomy according to Gächter stage. However, 28% required re-operations for persistent infection: secondary procedures included further irrigation and debridement with the arthroscopic or arthrotomic approach. Conclusion Gächter classification showed a crucial prognostic role in predicting the outcome of surgical treatment of septic knee arthritis. Regardless of the procedure performed, a prompt operation and an accurate debridement of the synovial membrane are the most critical factors for eradicating infection and good clinical outcomes. Level of Evidence Level II, prognostic study

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“…It is estimated that in the United States (US), in 2040, the number of primary total hip and total knee replacement (THR, TKR) will increase of 284% and 401%, respectively [ 5 ]. Despite the majority of JR operations offering pain relief, and potential functional and quality of life improvement, a minority of patients will require additional surgery as a result of both aseptic and septic failures [ 6 , 7 , 8 ]. The aseptic failure, affecting the 28% of the total JRs, includes loosening at the bone cement interface, periprosthetic fracture, fracture, wear, implant malposition, dislocation-instability, or materials fatigue [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

A Customized Knee Antibiotic-Loaded PMMA Spacer: A Preliminary Design Analysis

et al. 2021

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A preliminary design of customized antibiotic-loaded poly-methyl-methacrylate (ALPMMA) spacer characterized by an appropriate footprint according to the specific patient’s anatomy and a reliable mechanical response to severe functional loads (i.e., level walking and 45° bent knee) is reported. The targeted virtual prototyping process takes origin from a novel patented 3D geometrical conceptualization characterized by added customization features and it is validated by a preliminary FEM-based analysis. Mechanical and thermomechanical properties of the antibiotic-doped orthopedic PMMA cement, which will be used for the future prototype manufacturing, were measured experimentally by testing samples taken during a real day-running orthopedic surgery and manufactured according to the surgeon protocol. FEM analysis results indicate that small area is subjected to intensive stresses, validating the proposed geometry from the mechanical point of view, under the two loading scenarios, moreover the value of safety margins results positive, and this is representative of the lower stress magnitude compared to the critical material limits. The experimental data confirm that the presence of antibiotic will last during the surgeon period moreover, the temperature dependent modulus of the bone cement is slightly affected by the body range temperature whereas it will drastically drop for higher temperature out the range of interest. A complete customization, according to a patient anatomy, and the corresponding real prototype spacer will be manufactured by 3D printing techniques, and it will be validated by destructive testing during the second stage of this activity before commercialization.

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Knee septic arthritis caused by α-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report

Cited by 6 publications

References 38 publications

Prosthetic knee joint infection caused by α-hemolytic Streptococcus species: a case report

Prosthetic knee joint infection caused by α-hemolytic Streptococcus species: a case report

The eradication rate of infection in septic knee arthritis according to the Gächter Classification: a systematic review

A Customized Knee Antibiotic-Loaded PMMA Spacer: A Preliminary Design Analysis

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