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.
___
1. Allum R. Review article. Complications of arthroscopy of the knee. J Bone Jt SurgBr. 2002;84(7):937e945.
2. Armstrong RW, Bolding F. Septic arthritis after arthroscopy:the contributing roles of intraarticular steroids and environmental factors. Am J Infect Control.1994;22(1):16e18.
3. Bert JM, Bert TM. Management of infections after arthroscopy. Sports MedArthrosc Rev. 2013;21(2):75e79.
4. Marmor S, Farman T, Lortat-Jacob A. Joint infection after knee arthroscopy: medicolegal aspects. Orthop Traumatol Surg Res. 2009;95(4):278e283.
5. Bohensky MA, deSteiger R, Kondogiannis C, et al. Adverse outcomes associated with elective knee arthroscopy: a population-based cohort study. Arthroscopy.2013;29(4):716e725.
6. Hagino T, Ochiai S, Watanabe Y, et al. Complications after arthroscopic knee surgery. Arch Orthop Trauma Surg. 2014;134(11):1561e1564.
7. Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection. From the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res. 2011;469(11):2992e2994.
8. Bonnaig NS, Casstevens EC, Freiberg RF. Posterior knee dislocation following septic arthritis of the knee. Geriatr Orthop Surg Rehabil. 2012;3(1):45e47.
9. Chu CM, Wang SJ, Wu SS. Posterior dislocation of a cruciate-retaining total knee arthroplasty following an acute bacterial infection. Arch Orthop Trauma Surg. 2003;123(2e3):121e124.
10. Polyzois VD, Grivas TB, Emmanouil DS, Vasiliades E, Gliatis I, Stavlas P. Management of knee dislocation because of posttraumatic septic arthritis neglected for 40 years. J Trauma. 2008;64(2):E21eE23.
11. Oostenbroek HJ, Van Roermund PM. Arthrodesis of the knee after an infected arthroplasty using the Ilizarov method. J Bone Jt Surg Br. 2001;83(1):50e54.
12. Lonner JH, Dessaj P, Dicesare PE, Steiner G, Zuckermann JD. The reliability of analysis of intraoperative frozen sections for identifying active infection during revision hip or knee arthroplasty. J Bone Jt Surg Am. 1996;78(10): 1553e1558.
13. Fink B, Makowiak C, Fuerst M, Berger I, Schafer P, Frommelt L. The values of EUR synovial biopsy and joint aspiration in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Jt Surg Br. 2008;90(7):874e878.
14. Fink B, Gebhard A, Fuerst M, Berger I, Schafer P. High diagnostic value of sy- EUR novial biopsy in periprosthetic joint infection of the hip. Clin Orthop Relat Res. 2013;471(3):956e964.
15. Chen CC, Lin HH, Hung SC, et al. Surgical treatment for septic arthritis of the knee joint in elderly patients:A 10-year retrospective clinical study. Orthopedics. 2013;36(4):e434ee443.
16. Gontarewicz A, Niggemeyer O, Tharun L, Grancicova L, Rüther W, Zustin J.Morphological study of synovial changes in two-stage reconstructions of theinfected hip and knee arthroplasties. BMJ Open. 2012;2(4). pii: e001467. http://dx.doi.org/10.1136/bmjopen-2012-001467. Print 2012.
17. Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Jt Surg Am. 2008;90(9):1869e1875.
18. Swank K, Dragon JL. Postarthroscopic infection in the knee following medical or dental procedures. Case Rep Orthop. 2013:974017. doi: 101155/2013/ 974017.
19. Stutz G, Kuster MS, Kleinstück, GEUR achter A. Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc. 2000;8(5):270e274.
20. Kodumuri P, Geutjens G, Kerr HL. Time delay between diagnosis and arthroscopic lavage in septic arthritis. Does it matter? Int Orthop. 2012;36(8):1727e1731.
21. Kuo CL, Chang JH, Wu CC, et al. Treatment of septic knee arthritis:comparison of arthroscopic debridement alone or combined with continuous closed irrigation-suction system. J Trauma. 2011;71(2):454e459.
22. Yanmıs¸ I, Ozkan H, Koca K, Kılınçoglu V, Bek D, Tunay S. The relation betweenthe arthroscopic findings and functional outcomes in patients with septic arthritis of the knee joint, treated with arthroscopic debridement and irrigation.Acta Orthop Traumatol Turc. 2011;45(2):94e99.