Post-steroid septic arthritis can be treated with irrigation pump assisted arthroscopic synovectomy. The high-intra-articular fluid pressures can force the pyogenic fluid into a pre-existing Baker's cyst. The cyst can rupture and with the pre-existing steroid induced immune-suppression, the calf abscess will be hard to control. Therefore, thorough investigation with an ultrasound-guided aspiration followed by an early drainage of the collection is warranted and mandatory. Close monitoring for the development of a deep thrombosis of the popliteal vein is required.
"This should be suspected in patients with a systemic infection and a popliteal cyst with local signs of infection . This has been illustrated in a case report of a patient with unilateral lower extremity swelling and pain as well as in another case report where septic arthritis was induced by a corticosteroid injection which was complicated by a pyogenic Baker’s cyst [43, 44]. There are many treatment options for a Baker’s cyst. "
[Show abstract][Hide abstract] ABSTRACT: Posterior knee pain is a common patient complaint. There are broad differential diagnoses of posterior knee pain ranging from common causes such as injury to the musculotendinous structures to less common causes such as osteochondroma. A precise understanding of knee anatomy, the physical examination, and of the differential diagnosis is needed to accurately evaluate and treat posterior knee pain. This article provides a review of the anatomy and important aspects of the history and physical examination when evaluating posterior knee pain. It concludes by discussing the causes and management of posterior knee pain.
Current Reviews in Musculoskeletal Medicine 10/2010; 3(1-4):3-10. DOI:10.1007/s12178-010-9057-4
[Show abstract][Hide abstract] ABSTRACT: We report a case of knee pyarthrosis in a 54-year-old woman with rheumatoid arthritis and a popliteal cyst. The onset of infection coincided with a cortisone injection. Initial management consisted of arthroscopic irrigation and debridement (I&D) on 2 consecutive occasions without resolution of the infection. Only after open excision of the popliteal cyst in conjunction with I&D of the knee joint proper did the infection resolve. This is the first reported case of a patient requiring excision of a popliteal cyst to clear pyarthrosis of the knee after failure of arthroscopic I&D. Consideration should be given to open debridement or drainage of popliteal cysts in patients who present with septic arthritis in the presence of a popliteal cyst. A treatment algorithm for managing this clinical scenario is presented.
Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2009; 25(6):696-700. DOI:10.1016/j.arthro.2009.02.024 · 3.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Septic arthritis associated with extra-articular abscess is rare. We report on 2 non-rheumatic patients with septic arthritis of the knee associated with calf abscess. Magnetic resonance imaging showed a distinct leakage pathway from the knee joint in each patient. One was a ruptured popliteal cyst (posteromedial). Another was a pathologic popliteus hiatus (posterolateral). These patients underwent open drainage of the calf abscess via a small incision, followed by arthroscopic debridement of the knee. Careful palpation of the lower leg, followed by magnetic resonance imaging and needle aspiration, is important to exclude a possible extra-articular abscess regardless of the presence of a popliteal cyst.
Journal of orthopaedic surgery (Hong Kong) 08/2012; 20(2):272-5. · 0.70 Impact Factor
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