Acute septic arthritis of the knee can lead to joint damage or sepsis, if early diagnosis and treatment fail to occur, which includes drainage of the joint, adequate antibiotic coverage and resting of the knee. Classically, drainage of the knee was performed either with multiple aspirations or open arhtrotomy. The arthroscopic approach has becoming widely accepted, as it allows adequate drainage of the pus and debridement with partial or total sinovectomy of the joint.

The aim of this study was to evaluate the differences between arthroscopy and open arthrotomy in the clinical outcomes and rate of recurrence in patients with septic arthritis of the knee joint.

We reviewed patients with acute septic arthritis of the knee admitted in our center between January 2010 and December 2014. The criteria for diagnosis was report of purulent material when arhtrotomy or arthroscopy was performed or a positive culture of the joint fluid. Patients with recent surgery or documented osteomyelitis of the femur or tíbia were excluded.

We used the Oxford Knee Score (OKS) to classify the clinical outcomes in the end of follow-up, and registered the rate of recurrence in each group. The statistical evaluation of the results was performed using Student's t-test.

65 patients were treated during this period, 37 by an open arthrotomy through a lateral supra-patellar aproach, and 28 by arthroscopy through 2 standard anterior portals. All the patients were imobilized with a cast or orthosis in the immediate post-operation period for a mean period of 13 days in the arthrotomy group (8–15) and 9 days in the arthroscopy group (6–12) and received endovenous antibiotics for at least 10 days, followed by oral antibiotics for a mean total of 36 days in the the arthrotomy group (30–48) and 32 days in the arthroscopy group (22–36). The mean follow-up was 22 months in the arthrotomy group (8–28 months) and 18 months in the arthroscopy group (14–24). The mean OKS was 31 in the the arthrotomy group (21–39) and 35 in the arthroscopy group (25–44). There was 1 recurrence in the arthrotomy group and 1 recurrence in the arthroscopic group, both managed by knee arthrotomy.

Drainage is a key step in treatment of knee pyoarthrosis, either through an open or an arthroscopic approach. Both seem to be equally effective, with no significant statistical difference in terms of recurrence. The functional results tend to favour the arthroscopic approach, but with no statistical significance.

Postoperative infection is a difficult complication affecting total hip arthroplasty. It is painful, disabling, costly and it lacks definitive treatment guidelines. Klebsiella spp. are uncommon causes of Total Hip Arthroplasty. The aim of this case report was to document an effective treatment algorithm for a multidrug resistant Klebsiella spp infection after THA.

We report a case of a 56-year-old male who has performed a THA in 2007 at our institution. After 4 admissions due to posterior hip dislocations it was performed an Acetabular Revision in May 2014. The periprothesic infection was suspected by delayed wound healing with inflammatory signals and both abnormal values of Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The patient was submitted to two hip arthrocenteses, one before and the other after antibiotic therapy (EV). The intra-articular cultures revealed a Klebsiella Pneumoniae infection only carbapenem-sensitive.

We decided to performed a two-stage total hip arthroplasty revision approach.

After the First Acetabular revision, ESR and CRP were augmented. X-rays and CT scans were performed, but inconclusive for infection. The patient completed longterm ertapenem therapy after the results of intra-articular cultures.

We repeated arthrocentesis and the result was positive for the same bacteria.

After 3 months of the Acetabular procedure we performed a Girldstone. We continued with Ertapenem and after 4 months we performed a Total Revision Arthroplasty. Final intra-articular cultures were negative for infection and ESR and CRP were both normal.

After 5 months of follow-up the patient is pain-free and has good ROM.

The infection risk is greater with the number of revision surgeries. Our institution has good outcomes with 2-stage procedure for multi drug infections. The best diagnosis tools were ESR and CRP, and intra-articular cultures. Two-stage revision surgery is a good choice for multi-resistent infections, and proper indications must be followed.