Joint infections

John Albright

Sports Conference

11-03-05

Case presentation #1

•      39 y/o male

•      Chronic recurrent instability episodes

Operative findings

Operative findings

•      Photos

Operative findings

•      Brief op not illustrations.??

Post Operative course

•      Brief op not illustrations.??

Case #2:  Exam

•      Stability

–  KT-1000:                        7 mm

–  Pivot shift:                       grade 2

–  Patellar motion:              100% 

–                height:               equal

–  Rotation:                         100%

•      Strength   quads            90%

•                       hamstrings    95%

Case #1:  X-rays

Case #1:  MRI

Case presentation #2

•      16 y/o ice hockey player

•      ACL repair 3 months ago (outside source)

–  Infected post op

–  Graft removed

–  IV antibiotics x 6 weeks

Case #2: labs

•      WBC’s

•      Sed rate

•      CRP

Case #2:  Exam

•      Temp:                                    Cool

•      Joint appearance                  WNL

•      Synovial lining                       WNL

Case #2:  Exam

•      Stability

–  KT-1000:                        7 mm

–  Pivot shift:                       grade 2

–  Patellar motion:              100% 

–                height:               equal

–  Rotation:                         100%

•      Strength   quads            90%

•                       hamstrings    95%

Case #2:  X-rays

Case #2:  MRI

Case #2:  Plan?

•      Re-operate?

–  When?

–  How?

•      Infection risk?

•      Complication risk?

Case #2:  Plan?

•      Interim management

–  Brace?

•   None

–  Rehabilitation program?

•   Pivot shift control program

Re-Infection risk

•      Literature on  waiting 6 mo

Case #2:  revision surgery

•      Brief op note diagram

Case #2:  revision surgery

•      Brief op note photos

Case #2:  revision surgery

•      Post op course

–  Slow recovery

–  Crepitus

–  Swelling with  activitiy

–  Depression

–  Stability:     excellent