Cutaneous Escherichia coli infection and necrosis after primary total knee arthroplasty: a case report

Primary total knee arthroplasty (TKA) is common and increasingly performed. Superficial surgical site infections, though rare, risk progressing to deep periprosthetic joint infection, posing a serious management challenge.

An 81-year-old woman underwent primary TKA for osteoarthritis. Three months postoperatively, she developed an 8 × 10 cm infected necrotic wound at the incision site after self-applying nonstandard topical agents. A multidisciplinary team performed staged debridement and reconstruction, achieving successful infection control and implant preservation.

This case illustrates a severe superficial infection progressing to extensive soft tissue necrosis due to inappropriate self-treatment. The successful outcome was achieved through timely and coordinated surgical interventions by a multidisciplinary team, highlighting the critical need for structured protocols in managing such complex scenarios. This approach effectively prevented the progression to periprosthetic infection and preserved the functional implant.

Multidisciplinary collaboration is essential for successfully managing complex post-TKA wound infections, providing a valuable framework for future high-risk orthopedic cases.