Polymicrobial periprosthetic joint infection and osteomyelitis of the tibia with circumferential abscess and skin ulcer 11 years after total knee arthroplasty

Radiology Case Reports

article

Yasuo Kunugiza¹  Takehiro Tanaka¹  Ryuichiro Hirota¹  Shigeki Kakunaga¹  Yasunori Okamoto¹  Shigeyoshi Tsuji¹ 

[1] Department of Orthopaedics, Japan Community Health Care Organization ,(JCHO), Hoshigaoka Medical Center

关键词: Skin ulcer;    Circumferential abscess;    Total knee arthroplasty;    Contrast-enhanced computed tomography;    Ring enhancement;   

DOI  :  10.1016/j.radcr.2022.07.070

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

We report the case of a 71-year-old woman with a skin ulcer derived from an abscess around the tibia. The abscess resulted in periprosthetic joint infection and osteomyelitis 11 years after total knee arthroplasty . The first symptom was a skin ulcer of the lower leg. Magnetic resonance imaging revealed a circumferential mass around the proximal tibia . A skin biopsy taken around the ulcer showed thrombosis and degenerated collagen. Contrast-enhanced computed tomography showed a circumferential mass around the proximal tibia with ring enhancement. Biopsies of the skin ulcer and circumferential mass showed an abscess caused by Enterococcus faecium and methicillin-resistant Staphylococcus epidermis . We conducted debridement of the abscess, a gastrocnemius flap and split-thickness skin grafting and a 2-stage revision of the total knee component with a hinged prosthesis. Two years later, the infection did not reoccur and the patient can walk without a cane. This case is unique as abscess around proximal tibia caused necrotic skin ulcer and appearance of abscess was fibrous and different from typical bacterial abscesses containing pus or fluid. Contrast-enhanced computed tomography was effective for differentiation of the pathological condition.

【 授权许可】

CC BY|CC BY-NC-ND