rifampin and Osteoarthritis--Knee

Choice of pins, drills, and drilling technique can result in heat generation leading to thermal necrosis of bone. This has been reported frequently in internal as well as in external fixation. This publication is the first report of a patient having osteomyelitis of the proximal tibia due to thermal necrosis following tracker pin placement in computer-navigated total knee arthroplasty.

Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Bone Nails; Floxacillin; Hot Temperature; Humans; Knee Joint; Knee Prosthesis; Male; Middle Aged; Necrosis; Osteoarthritis, Knee; Osteomyelitis; Prosthesis-Related Infections; Radiography; Rifampin; Surgery, Computer-Assisted; Tibia; Treatment Outcome

In a man with osteoarthritis of the knee, Actinomyces naeslundii septic arthritis developed after intra-articular injection of hyaluronate. Actinomyces is an anaerobic Gram-positive rod. The outcome was favorable after treatment with two antibiotics and arthroscopy. The nature of the organism and its location to a joint are unusual features of this case, which illustrates the need to search for a septic complication before accepting a diagnosis of inflammation related to hyaluronate injection.

Topics: Actinomyces; Actinomycosis; Aged; Amoxicillin; Arthritis, Infectious; Drug Therapy, Combination; Humans; Hyaluronic Acid; Injections, Intra-Articular; Knee Joint; Male; Osteoarthritis, Knee; Rifampin; Treatment Outcome

Tuberculous synovitis frequently presents as a monoarthritis of weight-bearing joints such as the hip, knee, or ankle. Owing to its low incidence in developed countries, the diagnosis is often delayed for months to years. Early diagnosis with a synovial biopsy permits prompt antituberculous therapy and substantially improves the prospect of preservation of joint structure and function. Initial treatment typically includes combination therapy with four drugs (isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol) because of the frequency of isoniazid resistance. Antimicrobial therapy should be of at least 9 months' duration, longer in immunocompromised hosts. Partial synovectomy and other surgical procedures should be restricted to joints with severe cartilage destruction, large abscesses, joint deformity, multiple drug resistance, or atypical mycobacteria.

Topics: Adult; Antitubercular Agents; Ethambutol; Humans; Isoniazid; Male; Mycobacterium; Osteoarthritis, Knee; Pyrazinamide; Rifampin; Streptomycin; Synovial Fluid; Tuberculosis, Osteoarticular