Rare Drug-Resistant Knee Infection Successfully Treated

Delhi: As antimicrobial resistance increasingly complicates infection management, orthopaedic specialists are encountering more cases where standard antibiotic treatment alone is insufficient.

In one such case, Dr. Simon Thomas, Director and Head of Robotic Joint Replacement & Reconstruction, Max Hospital , successfully treated an 85-year-old patient with a drug-resistant knee implant infection through a carefully planned, staged surgical approach, demonstrating how complex infections can be managed effectively with timely, evidence-based care.

Implant-related infections present challenges distinct from routine infections. In joint replacements, bacteria can adhere to the implant surface and form a biofilm, reducing the effectiveness of antibiotics if treatment is initiated without identifying the infecting organism.

The issue has gained wider attention amid growing concerns around antimicrobial resistance, which has also been highlighted at a national level. In a recent episode of Mann Ki Baat, Prime Minister Narendra Modi cautioned against the misuse and overuse of antibiotics, noting that indiscriminate use can weaken their effectiveness over time.

When antibiotics are started without culture confirmation, resistant bacteria may persist, making infections harder to eradicate and recovery more prolonged.

In this case, the patient, Mrs Pushpa , had undergone bilateral knee replacement surgery in March 2022 and remained active for several years. In early 2025, she developed persistent pain and swelling in both knees.

Further evaluation, including joint fluid analysis and laboratory investigations, identified Achromobacter xylosoxidans, a rare organism known for resistance to commonly used antibiotics. Implant-related infections require specialised management, particularly in elderly patients, where treatment decisions must carefully balance infection control with overall safety.

Explaining the clinical approach, Dr. Simon Thomas, Director and Head of Robotic Joint Replacement & Reconstruction, Max Hospital , said, “Implant-related infections are especially challenging today because antimicrobial resistance limits treatment options.

In these cases, starting antibiotics without identifying the organism can allow resistant bacteria to persist. A step-by-step approach, based on accurate diagnosis, targeted antibiotics, and timely surgery, is essential to control the infection while protecting long-term joint function.”

Adding to this, Dr. Divesh Gulati, Associate Director – Robotic Joint Replacements & Orthopaedics, Max Hospital, Shalimar Bagh , said, “Cases like this underline the importance of restraint and precision in infection management.

When antimicrobial resistance is involved, every decision—from investigation to intervention—must be deliberate. A structured, staged strategy not only improves outcomes but also avoids unnecessary procedures, which is especially critical in elderly patients.”

Mrs Pushpa added, “At my age, the infection was worrying, and I was unsure how well I would recover. The treatment was explained clearly and carried out step by step, which helped reassure me. I am now recovering steadily and able to move better.”

In May 2025, the infected implant from the patient’s left knee was removed, and the joint was thoroughly cleaned. This was followed by high-dose, culture-specific antibiotic therapy. After infection parameters stabilised, a second-stage revision knee replacement was performed using a high-stability implant, with intra-operative checks confirming infection clearance before implantation.

During the same hospital stay, the patient’s right knee, which showed raised inflammatory markers, was evaluated cautiously through joint aspiration and laboratory testing, helping rule out active infection and avoid unnecessary surgery. Despite her age, the patient tolerated the procedures well and is currently undergoing supervised rehabilitation to improve mobility and daily function.

The case highlights the growing clinical impact of antimicrobial resistance and the need for early diagnosis, targeted treatment, and appropriate surgical intervention. It demonstrates that with specialised care and careful planning, even complex, drug-resistant implant infections can be managed successfully in elderly patients.