Two-stage Arthroplasty for the Treatment of Chronic Osteomyelitis After Routine Arthroscopic Knee Surgery

Abstract

Corynebacterium pseudodiphtheriticum is a normal inhabitant of the upper respiratory tract and is rarely thought of as a true pathogen. Although this microorganism has been associated with respiratory complications, a few case reports have demonstrated its ability to cause orthopedic infections. A recent review of the literature was performed regarding this specific bacteria and its association with bone and joint infection. To the author's knowledge, the current case is the first reported case of chronic osteomyelitis from Corynebacterium pseudodiphtheriticum after arthroscopic knee surgery. Isolation of this bacterial species on routine microbial cultures has been proven to be challenging in prior studies. In the current case, difficulty isolating this bacterial species on routine cultures led to a significant delay in diagnosis, which ultimately resulted in end-stage joint destruction. Treatment of the infection was accomplished using a 2-stage total knee arthroplasty technique, with the initial placement of an articulated, antibiotic-loaded spacer followed by a subsequent conversion to total knee arthroplasty. This case serves as a useful reminder that clinically subtle infections can occur after minor orthopedic surgery. Surgeons must remain vigilant to render a timely diagnosis and avoid severe sequelae that can result from an undetected pathogen after arthroscopic surgery.

Short-interval two-stage approach to primary total knee arthroplasty for acutely septic osteoarthritic knees

“…Again, antibiotic treatment was not further described. Besides the studies of Nazarian et al and Shaikh et al, four case reports with consistent results have been published [13, 20–22].…”

“…Therapeutic approaches include debridement and administration of high concentrations of systemic and local antibiotics as the first stage before considering total knee arthroplasty (TKA) [12,20,21], as well as arthrodesis or amputation in cases where previous surgical attempts have failed [36]. Although in the situation of periprosthetic joint infection (PJI) the twostage approach using antibiotic-loaded cement spacers, later followed by revision TKA has been studied extensively [10,11,14,17,26,33,38], only few case reports on two-stage TKA for arthritis with coexistent joint infection have been published [13,[20][21][22][23]32]. Research presented thus far reports consistent infection eradication therefore suggesting that a two-stage approach is a viable option in these rare situations.…”

Characteristics of Multidrug-Resistant <i>Corynebacterium</i> spp. Isolated from Blood Cultures of Hospitalized Patients in Japan

“…However, Corynebacterium spp. has been increasingly recognized as an important cause of significant human infections including respiratory tract infections (3), surgical site infections (4), prosthetic joint infections (5), endocarditis (6), osteomyelitis (7), and other infections. Recently, Corynebacterium spp.…”

Two-stage Total Knee Arthroplasty in the Treatment of Advanced Knee Septic Arthritis: A Single-center Experience

“…Previous studies were mostly case reports 3,[11][12][13] , and evidences regarding the therapy aspect was limited.…”