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Chronically Exposed Knee Hardware

  • Alyson Dobracki
Published/Copyright: March 1, 2020
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 120 Issue 3

A 66-year-old man who did not routinely seek medical care presented to the hospital with generalized weakness for 4 days. He described chronic right knee pain. Medical history included untreated rheumatoid arthritis and bilateral knee replacement 16 years prior. On examination, his right knee was fixed at 45-degree flexion. Femoral hardware and pus protruded through hyperemic skin (image A). He and his family claimed the hardware had been exposed for “years,” beginning with a small skin opening. Accumulation of detritus material is shown in image B.

The clinical findings met the Infectious Disease Society of America's definition of prosthetic joint infection by virtue of the persisting sinus tract.1 Plain radiographs were concerning for tibial and femoral osteomyelitis, and there was distal- to mid-femoral osteolysis with complete destruction of the femoral metaphysis. Because of the extent of proximal bone involvement and concern for noncompliance if multiphase intervention were pursued, above-the-knee amputation was deemed the most viable option. Although nonsurgical, palliative measures for exposed hardware have been accomplished,2 the patient's age and ability to rehabilitate led to this approach. Patients with rheumatoid arthritis have a higher risk of prosthetic joint infection.3 Treatment should take into account patient preferences and rehabilitation potential.

From Main Line Health at Bryn Mawr Hospital in Pennsylvania.
Financial Disclosures: None reported.
Support: None reported.

*Address correspondence to Alyson Dobracki, DO, Main Line Health, Bryn Mawr Hospital, 130 S Bryn Mawr Ave, Bryn Mawr, PA, 19010-3121. Email:

References

1. OsmonDR, BerbariEF, BerendtAR, et al.. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis.2013;56(1):e1-e25. doi:10.1093/cid/cis803Search in Google Scholar PubMed

2. ZamaniN, BarshesNR. Long-term wound palliation to manage exposed hardware in the setting of peripheral arterial disease.Plast Reconstr Surg Glob Open.2019;7(2):e2058. doi:10.1097/GOX.0000000000002058Search in Google Scholar PubMed PubMed Central

3. LenguerrandE, WhitehouseMR, BeswickAD, et al.. Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis.2019;19(6):589-600. doi:10.1016/S1473-3099(18)30755-2Search in Google Scholar PubMed PubMed Central

Received: 2019-06-19
Accepted: 2019-06-24
Published Online: 2020-03-01
Published in Print: 2020-03-01

© 2020 American Osteopathic Association

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https://doi.org/10.7556/jaoa.2020.034

Articles in the same Issue

  1. OMT MINUTE
  2. Osteopathic Manipulative Treatment for Pediatric Patients With Otitis Media
  3. ABSTRACTS
  4. Educating Leaders 2019: Abstracts From AACOM's Annual Conference
  5. HEALTH POLICY
  6. Value of the Continuing Certification Modules and Challenging the Status Quo
  7. ORIGINAL CONTRIBUTION
  8. Effect of Osteopathic Manipulative Therapy on Generalized Anxiety Disorder
  9. Daily Integrated Care Conferences to Reduce Length of Hospital Stay for Patients With Chronic Obstructive Pulmonary Disease
  10. Characteristics and Treatment of Pediatric Patients in an Osteopathic Manipulative Medicine Clinic
  11. BRIEF REPORT
  12. Assessment and Management of Somatic Dysfunctions in Patients With Patellofemoral Pain Syndrome
  13. CLINICAL REVIEW
  14. Antidepressant Discontinuation Syndrome: A Common but Underappreciated Clinical Problem
  15. CLINICAL PRACTICE
  16. Osteopathic Treatment Approach to Psychoemotional Trauma by Means of Bifocal Integration
  17. JAOA/AACOM MEDICAL EDUCATION
  18. CATALYST: Piloting a Longitudinal Assessment and Learning Program for Board Recertification and Continuous Professional Development
  19. CASE REPORT
  20. Platelet-Rich Plasma and Epidural Platelet Lysate: Novel Treatment for Lumbar Disk Herniation
  21. CLINICAL IMAGES
  22. Chronically Exposed Knee Hardware
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