Case report: Management of septic knee arthritis with Pseudomonas aeruginosa by arthroscopic debridement and lavage with diluted povidone iodine

Abstract

Introduction

Septic knee arthritis after elective arthroscopic procedures is a rare surgical emergency, with Pseudomonas aeruginosa even more rarely causing the infection. The treatment by arthroscopic debridement and lavage with diluted Povidone-Iodine has potential benefits that may be useful in improving the prognosis for patients. This case report discusses the potential benefits of using antiseptics like Povidone-Iodine in the washout of the affected joint.

Presentation of case

We present a patient with post arthroscopic septic knee arthritis caused by P. aeruginosa treated successfully by arthroscopic synovectomy and washout with normal saline and diluted povidone‑iodine, and prolonged antimicrobial therapy.

Discussion

Preceding reports of P. aeruginosa suggest intraoperative factors, postoperative factors, and host factors that may lead to this uncommon infection. There is controversy over the optimal management regarding arthroscopic versus open debridement, and the choice of the irrigating fluid.

Conclusion

The use of antiseptics like Povidone-Iodine in the washout procedure may lead to improved outcomes if used for a short controlled period of time and followed by copious irrigation with saline. Further studies must be done to determine the efficacy and risk-to-benefit ratio of this method.

Highlights

• •

  Pseudomonas aeruginosa causing septic arthritis without any risk factors are unusual.

• •

  Treatment approach for septic knee arthritis is controversial.

• •

  The type of irrigating fluid used in septic arthritis washout is not well defined by international guidelines

• •

  Use of 2.5% Povidine-Iodine in joint lavage for a short time is safe and effective in treating septic arthritis.