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Treatment Model for Young Patients with Psychogenic Erectile Dysfunction and Resultant Infertility
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Discussing treatment options.

James D Capozzi1, Rosamond Rhodes, Darwin Chen

  • 1Department of Orthopaedic Surgery, Winthrop University Hospital, 222 North Station Road, Mineola, NY 11501, USA. capoz5@aol.com

The Journal of Bone and Joint Surgery. American Volume
|March 4, 2009
PubMed
Summary
This summary is machine-generated.

A patient with recurrent periprosthetic knee infection underwent multiple surgeries. Despite high risks, he chose radical reconstruction over amputation to save his knee.

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Area of Science:

  • Orthopaedic Surgery
  • Infectious Disease
  • Reconstructive Surgery

Background:

  • Periprosthetic joint infection (PJI) is a serious complication following total knee arthroplasty (TKA).
  • Management of recurrent PJI, especially with extensive tissue damage, presents significant challenges.

Observation:

  • A 60-year-old male developed recurrent PJI after TKA, requiring component removal, antibiotic spacer placement, and suppression therapy.
  • A subsequent revision TKA failed, leading to another infection and necessitating radical débridement of the necrotic extensor mechanism.
  • The patient was presented with options including arthrodesis, resection arthroplasty, amputation, or complex revision with allograft and flap closure.

Findings:

  • The patient elected to undergo a high-risk, radical revision TKA with extensor mechanism allograft and potential flap closure, despite the procedure's unproven success rate and significant risks.
  • Intraoperative cultures during the revision surgeries were negative, but the extensor mechanism was necrotic, requiring extensive debridement.

Implications:

  • This case highlights the complex decision-making process in managing challenging periprosthetic joint infections.
  • Patient preference can significantly influence treatment choices, even when faced with high-risk, unconventional procedures.
  • Successful limb salvage in such severe cases may require multidisciplinary collaboration and innovative reconstructive techniques.