EC Orthopaedics

Background: Deep surgical site infection (SSI) after medial open-wedge high tibial osteotomy (MOWHTO) is considered one of the most detrimental complications. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) infection after MOWHTO, in which the patient underwent treatment to control the infection without hardware removal in the first stage.

Case Presentation: A 54-year-old man diagnosed with left knee osteoarthritis underwent MOWHTO. A deep SSI after MOWHTO appeared 3 weeks after the operation. Debridement, placement of vancomycin-containing bone cement adjacent to the implants, percutaneous drainage for 2 weeks after surgery, and intravenous daptomycin administration with oral minocycline were performed without implants removal for 2 months. However, the infection did not subside. hardware without synthetic bone substitute was removed 3 months after MOWHTO. A long-leg brace was placed on the left leg for 3 months after surgery. A bony union was observed on radiography 16 months postoperatively. The wound was in good condition with no recurrence of infection, and Hospital for Special Surgery (HSS)score was 86.

Conclusion: The treatment for deep SSI after MOWHTO is difficult. Treatment options may also be considered depending on the degree of deep SSI, bacterial type, and patient condition.

 Keywords: Medial Open Wedge High Tibial Osteotomy; Infection; Methicillin Resistant Staphylococcus aureus

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