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Pyoderma Gangrenosum After Bilateral Total Knee Arthroplasty.
Reilly Loomis1, Mellanie Merrit2, Maria Alexandrovna Aleshin3
1Palo Alto Medical Foundation, Center for Total Joint Replacement, Palo Alto, CA.
Arthroplasty Today
|September 6, 2021
Summary
Pyoderma gangrenosum is a rare complication following total knee arthroplasty. Early diagnosis and corticosteroid treatment are crucial for managing this aseptic wound breakdown.
Area of Science:
- Dermatology
- Orthopedic Surgery
Background:
- Pyoderma gangrenosum (PG) is a neutrophilic dermatosis.
- PG can mimic infectious processes like necrotizing fasciitis.
- It may occur post-surgically, complicating wound healing.
Observation:
- A 62-year-old male developed wound breakdown, fever, and elevated white blood cells 9 days after bilateral total knee arthroplasty.
- Initial treatments including debridement and antibiotics were ineffective.
- Infectious etiologies were ruled out via negative cultures and aspirates.
Findings:
- The patient was diagnosed with pyoderma gangrenosum after a skin biopsy and dermatologic consultation.
- Corticosteroid therapy led to rapid improvement.
- Soft-tissue defects were successfully repaired using skin substitutes and grafts.
Implications:
- Pyoderma gangrenosum is a rare but serious complication of total knee arthroplasty.
- Consider PG in cases of aseptic wound breakdown post-arthroplasty.
- Prompt dermatologic consultation and appropriate immunosuppressive therapy are vital.
Keywords:
Necrotizing fasciitisPathergyProsthetic joint infectionPyoderma gangrenosumTotal knee arthroplastyMore Related Videos
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