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Paternalism.

J D Capozzi1, R Rhodes

  • 1Department of Orthopaedics, Mount Sinai Medical Center, New York, NY 10128, USA.

The Journal of Bone and Joint Surgery. American Volume
|July 20, 2000
PubMed
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A sixty-five-year-old man with a right total knee replacement experienced recurrent knee sepsis and cachexia. Despite multiple treatments, the infection persisted, leading to the recommendation for component removal.

Area of Science:

  • Orthopaedic Surgery
  • Infectious Disease
  • Medical Ethics

Background:

  • A patient with a history of right total knee replacement presented with recurrent sepsis.
  • Initial treatment involved arthroscopic debridement and intravenous antibiotics, but the patient left against medical advice.

Observation:

  • The patient presented with severe knee infection (80,000 WBC/mm³), cachexia, and altered mental status.
  • Diagnostic workup for metastatic disease and occult neoplasm was negative.
  • Psychiatric evaluations determined decisional incapacity, later reversed at a skilled-nursing facility.

Findings:

  • Despite surgical debridement and antibiotics, the knee infection persisted.
  • The patient refused recommended surgical intervention (component removal) due to a desire to retain the knee replacement.
Keywords:
Professional Patient Relationship

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  • The medical team concluded that infection control was not feasible with the components in place.

    • Implications:

    • This case highlights challenges in managing persistent periprosthetic joint infections, especially with patient non-compliance.
    • Decisional capacity and patient preferences significantly impact treatment pathways for complex orthopaedic infections.
    • Effective management requires a multidisciplinary approach, addressing both infectious and psychosocial aspects.