Concomitant Septic Arthritis and Tophaceous Gout of the Knee Managed with Intermittent Closed Joint Irrigation Combined with Negative Pressure Therapy: A Case Study and Literature Review

V.N. Panicker*, 1, 2, J.K. Turner1, M.J. Chehade1, 2
1 Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia
2 Discipline of Orthopaedics & Trauma, Centre for Orthopaedic Trauma & Research, University of Adelaide, Australia

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© Panicker et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Plastic Surgery & Wound Management, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; Tel: +618 82225819; E-mail:


Tophaceous gout complicated by septic arthritis presents a management dilemma which can often require multiple surgical debridements. There is little published in the literature regarding treatment of these concomitant conditions. We postulate that biofilm may play a role increasing the difficulty of sterilising a tophaceous joint. The use of topical negative pressure therapy that targets biofilm has been well established for a range of wounds. A new device that incorporates both intermittent negative pressure therapy and wound irrigation was introduced in 2012. This case report describes the use of this topical negative device with the instillation option in the management of severe septic arthritis with concomitant gout and suggests directions for further research.

Keywords: Biofilm, septic arthritis, Gout, negative pressure wound therapy.