Missed Diagnosis of Septic Knee Joint With Patient Abandoned by Physician


This case involves a 64-year-old patient that presented to the hospital with severe knee pain. The ER staff contacted the orthopedist on call for instructions on how to manage this patient and they were told to aspirate the knee and drain fluids for cultures. After several failed attempts, the ER contacted the orthopedist again, who instructed them to send the patient home with pain medications. A few days later, the patient sought out the original orthopedist and went to the hospital where the doctor was working.  The doctor refused to see the patient and ultimately abandoned the case.  The patient went to another orthopedist who rushed the patient into surgery later that week. The patient developed sepsis, respiratory failure, and died shortly after the procedure due to a failure to timely treat the septic knee joint.

Question(s) For Expert Witness

  • What is the standard of care in treating a patient that presents with severe knee pain?

Expert Witness Response E-004339

Adequate drainage of a septic joint is the cornerstone of successful treatment. Staphylococcus aureus is the most prevalent and most virulent organism involved; without drainage, rapid destruction of the joint proceeds quickly. In many cases, needle aspiration can serve as the initial diagnostic and therapeutic intervention. If rapid improvement is not achieved, however, open drainage and lavage, arthroscopically or via arthrotomy, are strongly recommended. For this physician to abandon this patient is a clear deviation from standard operating procedure and would be considered negligent without a doubt.

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