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

Chul-Young Jung; Il-Soo Eun; Young-Chul Ko; Man-Jun Park; Min-Woo Kim; Keum-Min Hwang

doi:10.4055/jkoa.2013.48.6.480

Journal List > J Korean Orthop Assoc > v.48(6) > 1013271

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Jung, Eun, Ko, Park, Kim, and Hwang: Late-Onset Infection of a Total Knee Arthroplasty Caused by Monomicrobial Klebsiella pneumoniae in a Patient with a Periprosthetic Fracture

Case Report

Journal of the Korean Orthopaedic Association 2013; 48(6): 480-485.

Published online: 26 December 2013

DOI: https://doi.org/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

Chul-Young Jung, M.D., Il-Soo Eun, M.D., Young-Chul Ko, M.D., Man-Jun Park, M.D., Min-Woo Kim, M.D., Keum-Min Hwang, M.D.

Department of Orthopaedic Surgery, Busan Medical Center, Busan, Korea.

Correspondence to: Il-Soo Eun, M.D. Department of Orthopaedic Surgery, Busan Medical Center, 359 Worldcup-daero, Yeonje-gu, Busan 611-736, Korea. TEL: +82-51-607-2866, FAX: +82-51-607-2551, dreun7@hanmail.net

Received 6 June 2013 Revised 18 August 2013 Accepted 7 October 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: total knee replacement, Klebsiella pneumoniae, periprosthetic fractures

Figures and Tables

Figure 1

Radiographs from the initial visit.

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.

Figure 3

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

Figure 4

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

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.

Figure 6

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

Table 1

Case Review of Infection of a Total Knee Arthroplasty Caused by Klebsiella pneumoniae

BC, blood culture; JF, joint fluid; iv, intravenous.

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