MedElevator
Войти в исследования Journal of clinical orthopaedics and trauma · 2026
Diagnostic pitfalls and conservative management of acute culture-negative arthritis following total knee arthroplasty.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Surroca Maria, Berbel-Arcobé Laura, Bernaus Marti, Veloso Margarita, Miguela Silvia, Font-Vizcarra Lluís
Аннотация
BACKGROUND: Acute inflammatory arthritis after total knee arthroplasty (TKA) may closely mimic acute hematogenous periprosthetic joint infection (PJI), often leading to invasive surgical treatment. When microbiological cultures are negative, distinguishing between infectious and non-infectious causes remains particularly challenging.
METHODS: We conducted a retrospective review of 11 episodes of acute arthritis in 9 patients following TKA treated between January 2012 and December 2021. Acute arthritis was defined by sudden onset of symptoms within 72 h after a previously pain-free period, regardless of time from arthroplasty. All cases had negative synovial fluid and intraoperative cultures and no documented antibiotic exposure prior to aspiration. Clinical presentation, laboratory findings, management strategies, and outcomes were analyzed.
RESULTS: The median patient age was 79 years. All patients presented with abrupt knee pain and swelling. Inflammatory markers were markedly elevated (median C-reactive protein 90 mg/L), and synovial leukocyte counts were high (median 75,883 cells/mm3; median polymorphonuclear cells 88.3%), exceeding commonly accepted thresholds for PJI. Despite this, all cultures remained negative. Seven episodes were initially treated surgically with debridement and antibiotics, while four were managed conservatively. All patients achieved clinical resolution. Two patients experienced a second episode, both resolving with non-steroidal anti-inflammatory drugs. No subsequent prosthetic joint infections were observed during a median follow-up of 36 months.
CONCLUSION: Acute inflammatory arthritis following TKA can present with synovial fluid and laboratory findings indistinguishable from PJI. In clinically stable patients with persistently negative cultures, absence of systemic signs of infection, and early clinical and laboratory improvement, a conservative management strategy with close monitoring may be considered to avoid unnecessary surgical intervention.
METHODS: We conducted a retrospective review of 11 episodes of acute arthritis in 9 patients following TKA treated between January 2012 and December 2021. Acute arthritis was defined by sudden onset of symptoms within 72 h after a previously pain-free period, regardless of time from arthroplasty. All cases had negative synovial fluid and intraoperative cultures and no documented antibiotic exposure prior to aspiration. Clinical presentation, laboratory findings, management strategies, and outcomes were analyzed.
RESULTS: The median patient age was 79 years. All patients presented with abrupt knee pain and swelling. Inflammatory markers were markedly elevated (median C-reactive protein 90 mg/L), and synovial leukocyte counts were high (median 75,883 cells/mm3; median polymorphonuclear cells 88.3%), exceeding commonly accepted thresholds for PJI. Despite this, all cultures remained negative. Seven episodes were initially treated surgically with debridement and antibiotics, while four were managed conservatively. All patients achieved clinical resolution. Two patients experienced a second episode, both resolving with non-steroidal anti-inflammatory drugs. No subsequent prosthetic joint infections were observed during a median follow-up of 36 months.
CONCLUSION: Acute inflammatory arthritis following TKA can present with synovial fluid and laboratory findings indistinguishable from PJI. In clinically stable patients with persistently negative cultures, absence of systemic signs of infection, and early clinical and laboratory improvement, a conservative management strategy with close monitoring may be considered to avoid unnecessary surgical intervention.