Knee Joint Infection Research Articles

Melatonin for Treatment and Prevention of Postoperative Delirium

Melatonin for Treatment and Prevention of Postoperative Delirium

Staged reimplantation of total knee arthroplasty after Candida infection

Prosthetic joint infection with Candida is uncommon. Only 28 cases have been reported in the English literature. Successful reimplantation after eradication of Candida infection has been reported in 3 hip joints and only 1 knee. We present the case of a 68-year-old woman with chronic Candida parapsilosis infection of a prosthetic knee joint. Removal of the prosthesis, thorough débridement, and antifungal therapy treated the infection successfully. Antifungal therapy included 6 weeks of parenteral administration of fluconazole followed by 4 weeks of oral fluconazole. The involved knee joint was reimplanted 3 months after initial treatment. The prosthetic joint was pain free and functioned satisfactorily during the ensuing 4 years. No recurrence of infection was noted. The principle in treating Candida prosthetic infection generally has been the same as that of bacterial prosthetic infection. In chronic cases, removal of implants, thorough débridement, and effective antifungal therapy are mandatory for the eradication of infection. Reimplantation of the prosthesis can be performed successfully in a staged surgical procedure with the interval between the 2 stages shortened to 3 months.

Risk factors for prosthetic joint infection: case-control study.

We conducted a matched case-control study to determine risk factors for the development of prosthetic joint infection. Cases were patients with prosthetic hip or knee joint infection. Controls were patients who underwent total hip or knee arthroplasty and did not develop prosthetic joint infection. A multiple logistic regression model indicated that risk factors for prosthetic joint infection were the development of a surgical site infection not involving the prosthesis (odds ratio [OR], 35.9; 95% confidence interval [CI], 8.3-154.6), a National Nosocomial Infections Surveillance (NNIS) System surgical patient risk index score of 1 (OR, 1.7; 95% CI, 1.2-2.3) or 2 (OR, 3.9; 95% CI, 2.0-7.5), the presence of a malignancy (OR, 3.1; 95% CI, 1.3-7.2), and a history of joint arthroplasty (OR, 2.0; 95% CI, 1.4-3.0). Our findings suggest that a surgical site infection not involving the joint prosthesis, an NNIS System surgical patient risk index score of 1 or 2, the presence of a malignancy, and a history of a joint arthroplasty are associated with an increased risk of prosthetic joint infection.

Listeria monocytogenes-lnfektion einer Kniealloarthroplastik bei einem Patienten mit chronischer Polyarthritis - Fallbericht einer seltenen Lokalisation

The clinical spectrum of Listeria monocytogenes infections includes meningitis, meningoencephalitis, sepsis and focal infections (i.e. osteomyelitis, spinal or brain abscesses, cholecystitis and arthritis). Literature on Listeria monocytogenes infections of prosthetic joints is very scarce. We report on a case of Listeria monocytogenes infection of prosthetic knee joint by a patient suffering from rheumatoid arthritis. We are also reviewing English literature 1996 on four infected prosthetic knee joints and nine prosthetic hip joints. Up to now 16 cases of septic arthritis of knee and hip joints by Listeria monocytogenes in adults have been described.

Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management.

We performed a retrospective study of knee joint infections after arthroscopic anterior cruciate ligament reconstruction at our institution. Two thousand five hundred anterior cruciate ligament reconstructions were performed between 1988 and 1993. Seven (0.3%) patients experienced postoperative deep infections of the knee. All anterior cruciate ligament reconstructions were performed using arthroscopically assisted techniques. Six (86%) of these patients had concomitant open procedures performed, including meniscal repair, posterolateral corner reconstruction, and medial collateral ligament reconstruction. Four patients had acute (< 2 weeks), two patients had subacute (2 weeks to 2 months), and one patient had late (> 2 months) infections. All patients had positive cultures from knee joint aspirates with the organisms Staphylococcus aureus, Staphylococcus epidermidis, Peptostreptococcus, or a combination thereof. All patients underwent immediate arthroscopic irrigation and debridement. All infections were intraarticular; six patients also had extraarticular sites of infection. Four patients underwent repeat irrigation and debridement at approximately 1 week. The anterior cruciate ligament graft was removed from four patients. All patients were treated with intravenous antibiotics for 4 to 6 weeks, protected weightbearing, and physical therapy. At a mean followup of 29 months, mean knee extension was 0 degree, and mean knee flexion was 122 degrees (range, 70 degrees to 135 degrees). Six (86%) patients had minimal to no pain in their operative knee, and they were satisfied with their functional results.

関節内ステロイド注入による化膿性膝関節炎の症例の検討 ５年以上経過例

Suppurative knee joint infection probably due to intraarticular steroid injection, has been increasing recently. In this study, we report the results of a follow-up survey conducted in eleven patients (chiefly those with over five-year course after onset) who were referred to our hospital from other medical institutions during the past ten years.For clinical assessment knee joint function was evaluated on the basis of the “SANDAIGAKU” tentative plan. On X-ray medial and lateral joint spaces were determined bilaterally on the frontal image of lower limbs in the standing position, and PF joint spaces were measured on the lateral image. Evaluation was made for each item before disease onset, one year after surgery, and at the time of final follow-up.All eight patients who could be followed up for over five years have experienced no recurrence of the suppurative arthritis after surgery, and their gait ability was relatively satisfactory. Total scores of the “SANDAIGAKU” tentative plan improved in four patients, declined by 15 points or less in three patients, and significantly declined in one patient. Medial joint space was 3.9mm on average before surgery, 2.6mm one year after surgery and 0.9mm at the time of the final survery. Lateral joint space was also reduced in size in chronological order from 4.6mm to 3.9mm and 2.0mm, respectively. PF joint space also chronologically decreased from 2.5mm to 1.3mm and 0.6mm, respectively.

Staphylococcal arthritis--effects of superoxide dismutase on infected knee joints of rabbits.

The effect of SOD on staphylococcal arthritis has not been successfully evaluated to date. We developed an animal model to investigate the correlation. Using 16 rabbits divided into four groups, we injected two groups with staphylococcus aureus and the other two with NaCl. One group in each was also injected with SOD. The presence of SOD activity in untreated and infected knee joints of rabbits over a period of 72 hours showed no significant difference. TBA-reactive substances (TBARS) measured in joint fluid and plasma did differ in each of the groups, with the highest values found in animals with septic arthritis treated with SOD. This finding corresponded especially with the histological investigation. Joints of infected animals intra-articularly injected with SOD also showed histologically significantly more inflammation, a higher amount of bacteria in the joint cavity, and more distinct joint damage than joints injected only with bacteria. The mechanisms responsible for this SOD effect remain to be determined.

Technic of synovectomy in the infected knee joint

In case of early diagnosis as well as correct indication and operation technique, synovectomy is an essential part in the treatment of an infected knee joint. The new formation of the synovia has been demonstrated by clinical/empirical as well as experimental studies, so that the alimentation of the cartilage can be normalized. Postoperative scarring due to adherence has to be prevented by continuous therapeutic exercises. In case of severe early infections, already existent severe cartilage lesions, and fibrous ankylosis, arthrodesis by means of external fixation is the method of choice. In these cases neither a healing of the infection nor a satisfactory function of the knee joint can be expected after the application of synovectomy.

Epidemic septic arthritis caused by Serratia marcescens and associated with a benzalkonium chloride antiseptic.

During a 6-week period, 10 patients were admitted to a hospital for treatment of knee or shoulder joint infections due to Serratia species. Isolates from eight patients were identified as Serratia marcescens with identical biochemical characteristics and antibiotic susceptibility patterns. Before the onset of infections, all patients had been treated by two orthopedic surgeons who shared an office. Studies revealed that infections were associated with previous joint injections (P = 4.44 X 10(-5] of methylprednisolone and lidocaine. Environmental cultures revealed that a canister of cotton balls soaked in aqueous benzalkonium chloride and two multiple-dose vials of methylprednisolone previously used by office personnel were contaminated with the epidemic strain of S. marcescens. The canister may have served as a potential reservoir for contamination of sterile solutions and equipment used for joint injections, of skin at the injection site, and of hands of personnel. No further cases occurred after the use of aqueous benzalkonium chloride was discontinued.

Synovectomy as treatment for purulent joint infection.

Conventional treatment of pyogenic knee joint infections leads to unsatisfactory results. Through early synovectomy, before cartilage damage and osteoarthritis appear, the infected focus can be "excised." Functional after-treatment avoids cartilage atrophy, wound adhesions, and muscle weakness. The excellent results after 26 knee joint infections confirm this.

Very deep high temperature burns associated with blunt abdomino-thoracic trauma

A 14-year-old boy with deep burns, blunt abdominal trauma and extensive muscle damage is described. The patient was operated on for a ruptured liver, developed acute tubular necrosis, had 3220 gr of necrotic tissue removed in serial tangential excisions, had an above elbow amputation of the left hand, removal of necrotic ribs and excisions of necrotic spinal processes, developed sepsis twice, empyema of right pleura, had open infected knee joints and was successfully treated until complete healing over a period of four months. The successful outcome seems to be due to early and aggressive surgical treatment, hemodialysis, total parenteral nutrition for over two months, antibiotic therapy, cryoprecipitate and devoted nursing, occupational and physiotherapy.

Treatment and results in acute pyogenic arthritis

Pyogenic arthritis poses a serious complication to the opening of a joint. In the past eight years we have treated 22 patients suffering from acute infection of the knee joint and the talo-crural joint. Cases with infection of osseous origin were excluded. Infection was mainly caused by contamination during ligament reconstruction. Our therapy consisted of emergency operative revision of the joint, removal of necrotic tissue, and installation of an irrigation-suction-drainage system. The joints were immobilized and systemic antibiotics were administered in all cases. In four cases the installation of the irrigation-suction-drainage system in the knee joint was performed percutaneously without opening the joint. Of these, three had to be reoperated as the infection could not be controlled. During recent years we preferred to use a 0.5% PVP-I-solution for irrigation, because of the antiseptic effect. Irrigation treatment is limited to a period of seven days. Two out of 15 cases of knee-joint infection and three cases out of seven of talo-crural-joint infection resulted in ankylosis. In cases in which treatment began in the first week after contamination almost all had excellent clinical results. Substantial previous damage to the joint or delayed treatment usually prevented complete restoration of the joint's function.

Antibiotic Penetration of Synovial Fluid in Infected and Normal Knee Joints

A spectrum of new and commonly used antibiotics was examined with regard to their ability to penetrate into joint fluid in normal and E. coli infected rabbit knee joints. In order to carry out this investigation a new, simple method of measuring antibiotics in very small amounts of synovial fluid was developed. Cephalothin, cefazolin, cefoxitin, carbenicillin, amikacin, and gentamicin all penetrated into synovial fluid effectively achieving peak concentrations within 30 minutes to one hour. Synovial fluid antibiotic concentrations at 2 hours were equal to or higher than simultaneous serum levels. This relationship persisted thereafter. Penetration of antibiotics into infected joints was dependent primarily on serum concentration and was not altered importantly by the presence of acute chronic or previous infection. Antibiotic doses employed were equivalent to clinical usage on a weight basis. Penetration of all antibiotics studied was satisfactory for use against their normally intended pathogens.

Knee joint infections with Staphylococcus aureus and Micrococcus species

In rabbit knees 600 Staphylococcus aureus organisms produced progressive infection in 50 per cent of the knees injected, whereas 5.3 times 10-7 Micrococcus species caused only transient colonization of the joints. Methicillin, cephacetrile, and clindamycin administered before injection of the staphylococci gave protection. Stainless-steel particles in the knee did not increase susceptibility to infection from injected micrococci but did make established micrococcal infections more persistent. Knees containing steel debris failed to become infected during prolonged staphylococcal bacteremia. Injected autologous blood, either fresh or three days old, did not increase susceptibility to infection. Large doses of steroids, given systemically or intraarticularly, decreased resistance to micrococcal infection and increased the destruction caused by infection due to this organism.

Infection of Knee Joint by Mycobacterium kansasii

EXTRAPULMONARY infections caused by unclassified acid-fast mycobacteria of Runyon group I photochromogenic type without accompanying pulmonary disease have been rarely reported. It is generally accepted that two of the Runyon groups' of atypical mycobacteria are capable of producing progressive disease. One is group I, photochromogenic<i>Mycobacterium kansasii</i>. This group is characterized by colonial pigmentation following purposeful exposure of the culture to light. These microorganisms often possess a natural resistance to the major antituberculous drugs in low concentration. Experience with in vitro drugsensitivity testing has taught the need for initially higher doses of drugs, particularly isoniazid (INH). It is with this well-defined group of mycobacteria that the present case is identified. Group III, nonchromogenic Battey strain of atypical mycobacteria, produces indolent disease that is difficult, if at all possible, to reproduce in laboratory animals. It possesses natural resistance to low concentrations of antituberculous drugs. It is easily differentiated from<i>M tuberculosis</i>

Infection of knee joint by Mycobacterium kansasii

Infection of knee joint by Mycobacterium kansasii

CASES OF INFECTED KNEE-JOINT TREATED BY INCISION, DRAINAGE, AND MOVEMENT.

CASES OF INFECTED KNEE-JOINT TREATED BY INCISION, DRAINAGE, AND MOVEMENT.