J Korean Orthop Assoc.  2013 Dec;48(6):480-485. 10.4055/jkoa.2013.48.6.480.

Late-Onset Infection of a Total Knee Arthroplasty Caused by Monomicrobial Klebsiella pneumoniae in a Patient with a Periprosthetic Fracture

• Jung CY
• Eun IS
• Ko YC
• Park MJ
• Kim MW
• Hwang KM

• KMID: 2185284
• DOI: http://doi.org/10.4055/jkoa.2013.48.6.480

Abstract

Septic arthritis caused by Klebsiella pneumonia in adults is rare and is rarely observed after total knee arthroplasty. Acute or early onset of septic arthritis caused by K. pneumoniae has been reported after total knee arthroplasty. However, to date the only one overseas case of late K. pneumoniae infection after total knee arthroplasty has been reported, with no such case in Korea. In addition, monomicrobial infections by K. pneumoniae are not frequently found but are found primarily in the form of polymicrobial infections. The purpose of this paper is to report on a case in which an 85-year-old female patient, who had undergone a total joint arthroplasty 11 years ago, developed the late onset of septic arthritis caused by monomicrobial K. pneumonia infection with a periprosthetic fracture through literature reviews.

Keyword

total knee replacement; Klebsiella pneumoniae; periprosthetic fractures

MeSH Terms

Adult
Aged, 80 and over
Arthritis, Infectious
Arthroplasty*
Arthroplasty, Replacement, Knee
Coinfection
Female
Humans
Joints
Klebsiella pneumoniae*
Klebsiella*
Knee*
Korea
Periprosthetic Fractures*
Pneumonia

Figure

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  Figure 1 Radiographs from the initial visit.

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  Figure 2 (A) Lateral view of X-ray shows a periprosthetic fracture. (B) Anteroposterior view of X-ray shows a periprosthetic fracture. (C) Gas formation around the knee of computed tomograpy scan.

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  Figure 3 Mucous, lactose positive colonies of Klebsiella pneumoniae on MacConkey agar.

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  Figure 4 (A) Intraoperative photograph shows pyogenic effusion. (B) Intraoperative photograph shows periprosthetic fracture.

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  Figure 5 (A) Intraoperative photograph of antibiotic cement spacer. (B) Intraoperative photograph of tension band wiring of fragments. (C) Anteroposterior view of postoperative radiograph. (D) Lateral view of postoperative radiograph.

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  Figure 6 Three-domension computed tomography of the left lower extremity. (A) Stenosis of the popliteal artery. (B) Occlusion of the posterior tibial artery.

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