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Case report
Simultaneous bilateral revision total knee arthroplasty following Abiotrophia defectiva infection
  1. Joseph Wan,
  2. Matthew P Larsen,
  3. Parag Panwalkar and
  4. Ali Mofidi
  1. Trauma & Orthopaedics, Morriston Hospital, Swansea, UK
  1. Correspondence to Joseph Wan; jywanjoseph{at}


A 65-year old man presented with 6-week history of bilateral knee pain and swelling, with difficulty mobilising. He had bilateral total knee arthroplasties in situ performed 5 years prior complicated by postoperative wound infection. Bilateral synovial fluid cultures were positive for Abiotrophia defectiva, and extensive investigations had not identified an extra-articular source of infection. Failing debridement antibiotic and implant retention procedure, the patient underwent a simultaneous bilateral 2-stage revision with articulated cement spacers impregnated with vancomycin and gentamycin. The patient received 6 weeks of intravenous antibiotics after each stage. A. defectiva is a nutritiously fastidious organism, posing a challenge for clinical laboratories to isolate and perform antimicrobial susceptibility testing, yet prosthetic joint infections caused by A. defectiva are scarce in literature and present atypically with subacute signs of chronic infection. This poses a diagnostic and therapeutic challenge, and two-stage revision is the only documented treatment that successfully eradicates the infection.

  • infections
  • bone and joint infections
  • orthopaedics
  • prosthesis failure
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  • Contributors The first author, JW, is primarily responsible for writing, drafting and literature review for the report. The second author, MPL, is responsible for data collection. The third author, PP, is responsible for reviewing and editing the report. The final author, AM, is responsible for supervising the writing of this case report and is the clinician with overall clinical responsibility for the treatment of the reported patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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