701 - Septic Arthritis Rehabilitation Complicated by Right Leg Foreign Body

Case Diagnosis: Septic Arthritis Rehabilitation Complicated by Right Leg Foreign Body

Case Description: A 63-year-old male with a history of hypertension, hyperlipidemia, diabetes, and previous herniated disc repair presented with right knee pain. Initial workup found a patient to have septic gouty arthritis of the right knee. Incision and drainage was done with subsequent wound vacuum removal. Synovial cultures revealed H. Influenzae, and patients later developed meningeal signs, and bacterial meningitis was confirmed. An aggressive antibiotic regimen resolved symptoms, and the patient was stabilized and transferred to an Inpatient Rehabilitation Facility (IRF). During his time, the patient had limited improvement with ranging of the R knee and inability to bear weight secondary to pain. Persistent pain and lack of improvement prompted further imaging, revealing a 2 cm intra-articular foreign body, likely from prior surgery. The patient was then referred to orthopedic surgery for removal.

Discussions: This case emphasizes the importance of maintaining a broad differential when evaluating persistent post-operative pain in rehabilitation. Potential complications such as joint necrosis, infection, deep vein thrombosis (DVT), or less common causes like iatrogenic trauma should be considered. Imaging is critical for diagnosis, particularly in the context of ongoing pain. While plain radiographs can detect some foreign bodies, additional modalities like ultrasound or CT scans may be necessary. This case underscores the need for a vigilant approach to identifying and managing unexpected complications, even after initial surgical intervention.

Conclusions: Rehabilitation physicians should have a low threshold for imaging in the presence of unexplained pain, considering starting with ultrasound in an inpatient rehab setting. A strong differential and prompt diagnostic workup are vital, even when patients arrive at IRF with a presumed diagnosis. Early identification of complications can significantly impact recovery outcomes and patient quality of life.