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Knee Surg Sports Traumatol Arthrosc (2010) 18:790793 DOI 10.1007/s00167-009-0976-9
KNEE
Septic arthritis of the knee joint secondary to adjacent chronic osteomyelitis of the femur in an adult
Woong-Kyo Jeong Jong-Hoon Park
Soon-Hyuck Lee Jong-Woong Park
Seung-Beom Han Dae-Hee Lee
Received: 8 June 2009 / Accepted: 14 October 2009 / Published online: 5 November 2009 Springer-Verlag 2009
Abstract The present report describes a case of septic knee arthritis secondary to reactivated chronic osteomyelitis. The osteolytic lesion observed on the initial radio-graphs resulted in further imaging studies including CT and MRI, which conrmed the diagnosis. Based on the patients history, physical ndings and imaging studies, we performed open debridement rather than arthroscopic surgery in order to treat the infected intraarticular knee joint and ream the femur intramedullary canal. Additionally, an antibiotic-impregnated cement rod was inserted into the medullary cavity to ll the dead space and eradicate the infection. A high index of suspicion combined with adequate comprehension of initial plain radiographs is essential for accurate diagnosis of septic knee arthritis with adjacent chronic osteomyelitis.
Keywords Septic arthritis Knee
Chronic osteomyelitis Antibiotic-impregnated cement rod
Introduction
Most reports of septic knee arthritis with adjacent osteomyelitis in the distal femur or proximal tibia have involved pediatric patients [4, 11]. A few reports involving adults have been in immunocompromised patients and have involved acute type osteomyelitis [1, 12]. Reports of septic arthritis secondary to adjacent chronic osteomyelitis are extremely rare nowadays, especially in adults.
The present report describes a rare case of a septic arthritis in adult of the knee joint secondary to chronic osteomyelitis of the femur, which was successfully treated with an antibiotic-impregnated cement rod. This case highlights that a high index of suspicion combined with adequate comprehension of initial plain radiographs is essential for early diagnosis. The patient and his family were informed that data concerning the case would be submitted for publication, and this case report was approved by our Institutional Review Board (ED09143).
Case report
A 59-year-old man was referred to our clinic due to persistent severe pain and swelling in the right knee, which had developed 3 weeks prior and had worsened 2 days prior without trauma. At the age of approximately 14 years, he missed 1 year of elementary school due to sustained painful...