Osteomielitis Patelar
Osteomielitis Patelar
Short communication
Patellar osteomyelitis presenting as prepatellar bursitis
Ho-Rim Choi ⁎
Dept of Orthopaedic Surgery, SoonChunHyang University Hospital, 23-20 BongMyung-dong, CheonAn, 330-721, Republic of Korea
Received 16 March 2007; received in revised form 23 April 2007; accepted 23 April 2007
Abstract
Peripatellar lesions causing knee pain include cellulitis, bursitis, synovitis, septic arthritis and patellar osteomyelitis. We present here two
cases of patellar osteomyelitis which were misdiagnosed as prepatellar bursitis. Operative treatment was required for these lesions. Patellar
osteomyelitis should always be considered when treating a peripatellar lesion, although it is very rare condition.
© 2007 Elsevier B.V. All rights reserved.
⁎ Tel.: +82 41 570 3641; fax: +82 41 572 7234. A 7-year-old boy was referred to our hospital for
E-mail address: [email protected]. persistent, painful swelling of his left knee, which had
0968-0160/$ - see front matter © 2007 Elsevier B.V. All rights reserved.
doi:10.1016/j.knee.2007.04.010
334 H.-R. Choi / The Knee 14 (2007) 333–335
Fig. 1. Tc99 m
bone scan shows increased uptake around the patella of the
right knee.
Fig. 3. The curetted materials show necrotic bone and acute inflammatory
cells (H&E, ×400).
developed 3 weeks prior. Two weeks later, the symptom was
aggravated, and the subject visited a private clinic. Under the
impression of septic arthritis, clinicians performed needle excision of inflamed prepatellar bursa. Through the orifice,
aspiration and saline irrigation of the joint with intravenous the patella was curetted and the cancellous bone was noted to
antibiotic administration at the local clinic. However, the be soft and vascular. Cultures from the bursa and patella both
symptom was not improved. On admission to our hospital, grew S. aureus. Microscopic evaluation of the curetted bone
the patient was afebrile and had a mild floating and swelling was consistent with osteomyelitis, showing acute inflamma-
of his knee with maximum tenderness over his patella. Simple tory change and granulation tissue. The patient received
X-ray showed no significant abnormality. Laboratory find- 3 weeks of intravenous cefazedone and 6 weeks of oral
ings included a WBC count of 10,200 with 78% neutrophils antibiotics. Although the patient showed no restriction of
and an ESR of 42 mm/h. The CRP level was 8.5 mg/L. A joint motion or activity at 1 year follow-up, radiographs
Tc99 m bone scan was interpreted to be negative. However, the showed fragmentation and elongation of the patella (Fig. 5).
MRI showed prepatellar soft tissue swelling with inflamma-
tory change and suspicious anterior cortical breakage of the 4. Discussion
patella (Fig. 4). With the impression that the patient had
prepatellar septic bursitis, we performed bursa removal on the Osteomyelitis of the patella is a very rare condition
second day of admission. At surgery, through a bursal stalk, a because the patella is largely cartilaginous prior to ossifica-
0.5 × 0.5 cm size cortical defect of the patella was found after tion, and it has a rich blood supply with contributions from
the extraosseous and intraosseous anatomic networks
following ossification. The absence of a physeal plate may
also account for the rare occurrence of hematogenous
osteomyelitis in the patella [2,6,8]. Trauma can play a role
Fig. 4. The axial and sagittal views of the MRI demonstrate inflammatory
Fig. 2. After removal of the bursa and curettage of the bony lesion of the thickening of the prepatellar bursa. There is a mild defect on the anterior
patella, a cavitary defect remained. cortex of the patella (arrows).
H.-R. Choi / The Knee 14 (2007) 333–335 335