An unexpected pathogen causing prosthetic joint infection following screening colonoscopy

Area of Science:

• Orthopedics
• Infectious Diseases
• Gastroenterology

Background:

• Total knee arthroplasty (TKA) patients are susceptible to prosthetic joint infections (PJIs).
• Screening colonoscopies are common procedures.
• Transient bacteremia can occur during endoscopic procedures.

Observation:

• A 61-year-old woman with a right TKA developed atraumatic right knee swelling, pain, and fevers two weeks post-colonoscopy.
• Knee aspiration suggested prosthetic joint infection.
• The patient was treated with irrigation and debridement, polyethylene exchange, and a 6-week course of oral metronidazole.

Findings:

• Cultures identified Bacteroides fragilis, suggesting a gastrointestinal source.
• The colonoscopy was presumed to have caused transient bacteremia, leading to seeding of the prosthetic knee joint.
• This case illustrates a potential complication of routine endoscopic procedures in TKA patients.

Implications:

• This case underscores the importance of considering prophylactic antibiotic guidelines for TKA patients undergoing endoscopic procedures.
• Implementing preventative strategies could reduce the incidence of PJIs following colonoscopies.
• Further research into optimal antibiotic prophylaxis protocols is warranted to protect orthopedic implant integrity.