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Case Report
Delayed hematogenous right knee prosthetic joint infection following a documented case of epididymo-orchitis
1 Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
2 Albany Medical College, Albany, NY, USA
3 Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Knoxville, TN, USA
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Michael Khnanisho
Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ
USA
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Article ID: 100031Z14MK2025
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Khnanisho M, Horne C, Haglin JM, Tarabichi S, Bingham JS. Delayed hematogenous right knee prosthetic joint infection following a documented case of epididymo-orchitis. J Case Rep Images Orthop Rheum 2025;7(2):1–5.ABSTRACT
Introduction: Total knee arthroplasty (TKA) is a widely performed elective procedure globally. Periprosthetic joint infection (PJI) remains a serious complication following TKA. Hematogenous seeding from distant infections is a recognized mechanism of PJI. However, to our knowledge, there are no published reports of hematogenous PJI originating from acute epididymo-orchitis.
Case Report: A 74-year-old male presented to the emergency department following a ground-level fall on his right knee. He was diagnosed with a knee effusion and discharged for outpatient follow-up. Approximately one week later, the patient presented to his primary care physician with right scrotal swelling and was diagnosed with epididymitis and started on oral antibiotics. The following day, he underwent right knee arthrocentesis which was positive for an acute PJI. The patient then underwent a double debridement, antibiotics and implant retention (DAIR) procedure and was discharged on a six-month course of oral antibiotics. Eight months after the double DAIR, the patient developed right knee swelling and erythema. Right knee aspiration was positive for a persistent PJI, and the patient underwent resection arthroplasty with insertion of an antibiotic spacer.
Conclusion: Hematogenous spread of epididymoorchitis resulting in PJI is a rare and underreported complication that has not been fully understood in the literature. In this case, several risk factors—such as the presence of a prosthetic joint, recent trauma, and chronic corticosteroid use—may have increased the patient’s susceptibility to infection. Close monitoring of inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate, and white blood cell count can aid in the early detection of septic arthritis and contribute to improved patient outcomes.
Keywords: Epididymo-orchitis, Hematogenous spread, Periprosthetic joint infection, Total knee arthroplasty
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Acknowledgments
Portions of this manuscript were reviewed using CHATGPT (GPT-4, OpenAI, https://chat.openai.com) to improve grammar and wording. The AI was not used to generate original content, analyze data, or interpret results. The authors have verified the accuracy of all components.
Author ContributionsMichael Khnanisho - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Carly Horne - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jack M Haglin - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Saad Tarabichi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Joshua S Bingham - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Michael Khnanisho et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
