Complex Primary Total Knee Replacement in a Post-septic Arthritis Knee-balancing Infection Risk and Functional Recovery

Background: Septic arthritis occurring in the knee after an intra-articular injection is an infrequent yet potentially devastating complication.It can lead to the body being overwhelmed by systemic sepsis and multiple organ dysfunction syndrome, posing significant challenges in management.We are presenting a case of a patient who experienced septic arthritis in the knee following an intra-articular injection and later had multi-organ dysfunction syndrome for which a staged total knee replacement (TKR) was planned.Aim: To achieve a pain-free, functional knee arthroplasty with no signs of infection without putting too much economic constraint on the patient.Case Presentation: An emergency arthrotomy or opening of the joint with extensive debridement were performed.Once the infection subsided, Patient was taken for first stage of a staged TKR where preliminary bone cuts were made; these were intended to facilitate a TKR at a later date, antibiotic loaded dynamic cement spacers were used to preserve joint integrity.After a long course of antibiotics, when indicators of inflammation had returned to normal, the TKR was performed.Results: The prior bone cuts taken during the first stage procedure resulted in substantially shorter definitive surgery.Ultimately, the patient regained good use of his knee, and the infection did not return with a 10-week postoperative Oxford knee score of 42.Conclusion: This instance emphasizes that a careful, phased plan for complicated arthritic knees as a sequel of sepsis can decrease the bone loss, time of recovery and cost of the final definitive joint replacement surgery.