Endoscopic Treatment of Stump Infection of the Residual Synovial Cavity After Through-the-Knee Amputation

Abstract

Case: We report the case of a 35-year-old patient who presented with a septic residual synovial cavity infection 8 weeks after a through-the-knee amputation because of a parosteal sarcoma. An endoscopic evacuation of the turbid fluid and synovial debridement through parapatellar portals as in a standard knee arthroscopy was performed, in conjunction with appropriate antibiotic therapy. One year postoperatively, there were no signs of residual infection. Conclusion:Endoscopic treatment of a septic stump infection of the residual synovial cavity after through-the-knee amputation is feasible. In our case, this approach resulted in rapid wound healing and early prosthesis mobility. Septic arthritis is a relatively rare condition with an incidence between 2 and 10 per 100,000 patients per year 1 . The most frequent joint to be affected is the knee, and after securing the diagnosis, a rapid combination of antibiotic therapy and removal of intra-articular pus by surgical evacuation is paramount 1 . Postoperative infection after a through-the-knee amputation (TKA) is a common problem, with superficial cellulitis in 13% and soft-tissue infection in 4%, yet no infection of the synovial cavity is specifically described in the literature up to date 2 . Although the TKA stump is anatomically not a knee joint anymore, the biological behavior of a residual synovial cavity in the case of infection may be comparable 1 . For nonamputated persons, arthroscopy has the advantage of shorter hospital stay and lower complication rate such as a lower rate of reinfection, making arthroscopic irrigation superior to open surgery 3,4 . Arthroscopic techniques also lead to smaller wounds and smaller scaring, which is paramount for patients with amputated lower extremities and especially in the case of an end weight-bearing stump such as a TKA.All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B971).