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

Salah Tewfik Daradkeh; Mohammad Jamal Abunasser; Yazan Tawfiq Daradkeh; Mohammad Suleiman Olimat; Waleed F Dabbas; Alaa Akel

doi:10.1016/j.ijscr.2021.106262

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

Int J Surg Case Rep. 2021 Aug:85:106262. doi: 10.1016/j.ijscr.2021.106262. Epub 2021 Aug 3.

Authors

Salah Tewfik Daradkeh¹, Mohammad Jamal Abunasser², Yazan Tawfiq Daradkeh³, Mohammad Suleiman Olimat⁴, Waleed F Dabbas⁵, Alaa Akel⁶

Affiliations

¹ Faculty of Medicine, Department of General Surgery and Special Surgery, Yarmouk University, Jordan. Electronic address: salah.daradkeh@yu.edu.jo.
² Faculty of Medicine, Yarmouk University, Jordan.
³ Irbid Health Directorate, Ministry of Health, Jordan.
⁴ University of Jordan Hospital, Jordan.
⁵ Clinical lecturer of Neurosurgery, Department of Special Surgery, Faculty of Medicine, Al-Balqa Applied University, Jordan. Electronic address: waleed.dabbas@bau.edu.jo.
⁶ Faculty of Medicine, Mutah University, Jordan. Electronic address: alaakel@mutah.edu.jo.

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.

Keywords: Arthroscopy; Case report; Povidone-iodine; Pseudomonas Aeruginosa; Septic arthritis.