Description

A 66-year-old woman presented with renal failure and purulent discharge associated with a chronic prosthetic joint infection (PJI) of the left knee. Her medical history consisted of an untreated chronic hepatitis B and recurrent giant-cell tumour of bone revealed by spontaneous fractures 20 years previously. Multiple tumour resections led to knee prosthesis implantation in 1992 with no tumour relapse thereafter. The patient experienced a methicillin-susceptible Staphylococcus aureus chronic PJI in the following months that required two-stage prosthesis replacement and a prolonged antibiotherapy. A clinical suspicion of superinfection was confirmed in 2002 by a puncture of the synovial fluid that found a methicillin-resistant Staphylococcus epidermidis. The patient declined both surgical and medical treatment and was lost to follow-up.

She subsequently presented in 2015 with partial impotence, no flexion of the left knee and multiple fistulae with purulent discharge (figure 1A) that had evolved for years and that had been treated with a self-made bandage. X-ray (figure 1B) and CT scan (figure 1C) found extensive periostea reaction of the femur, bone destruction and prosthesis loosening. Lab results found …