Case Study: Arthroscopic lavage and drainage
of the left knee with septic arthritis in a 88 year-old man
When there is a significant infection in a joint, surgery to drain and clean up the joint or joints is performed. Septic arthritis is the medical term for the infection. Infected fluid and debris are removed from the joint during surgery. This surgery is commonly performed on the knee, hip, and shoulder joints.
Adults with septic arthritis of the knee: arthroscopy or arthrotomy? In adults, the treatment of choice for septic arthritis of the knee is arthroscopic drainage with synovectomy.
An 88-year-old man patient came to the office with a history of CAD with PPM, hypertension, hyperlipidemia, and thrombocytopenia presented with left knee pain and swelling on Friday night.
There is no accompanying trauma. The patient complains that he is experiencing trouble walking. Fever, chills, headache, fuzzy vision, dysuria, hematuria, chest pain, and shortness of breath are all denied.
The condition has been worsening for 7 days, with no fever, chills, or other symptoms. The patient has a history of a similar infection in the knee and has had two arthroscopic washouts. He has had additional orthopedic operations that have gone well.
After two weeks the patient was seen in the office for his post operative visits, no x-rays were needed. He is able to walk with a walker with knee immobilizer with little discomfort. He is able to do meaningful ROM and is doing PT. He is using a walker for ambulation.
We opted to proceed with official physical therapy as well as a home workout regimen for knee rehabilitation after examining treatment choices. During the current visit, the stitches were removed. We will continue to use ice and elevate the knee to reduce swelling and pain.
To limit the risk of deep vein thrombosis, we will continue to use early mobilization and mechanical prophylaxis. We will gradually wean them off any narcotic medications and transition them to anti-inflammatories and Tylenol as long as there are no contraindications. He will continue to receive IV antibiotics as directed by his PCP.
During the present appointment, we also addressed the risks, advantages, and common adverse effects of taking these medications. I’ll visit them again in three weeks/PRN to assess their improvement. They will contact us in the meantime if they have any questions or concerns before their follow-up appointment.
Following left knee arthroscopy and washout because of septic arthritis, the patient improved well in her care PT. The patient was taught about post-op precautions, signs and symptoms of intention, a progressive HEP, state transfers, safe ambulation with suitable assistive aids, and step management.
With a SAC 150, the patient progressed from utilizing a wheelchair for home mobility to independent ambulation. On outdoor surfaces, the patient can safely ambulate up to 250′ and manage a single stride or sink independently using 2WW.
He can conduct all home transfers independently and ADLs with setup assistance. Furthermore, the patient has increased mobility and balance, as evidenced by a Tinetti score of 22/29 and a TUG time of 14 seconds.
Patient has completed all goals and is being released from P and the agency. It was suggested that the patient continue treatment in an outpatient facility, however the patient declined at this time. A suggestion for a part B provider to make home visits is also made, but the patient declines this as well, preferring to continue on his own at home.
The patient is still making improvement, albeit slowly, with help of monthly examinations and physical treatment and at home.
Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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