Prophylactic antibiotic in genicular nerve block / RFA?

[Member10billion]

I have a patient with a remote (>20year) hx of MRSA infection of the left knee after a meniscectomy. She has not had an issue since then. Not able to have L TKA due to this previous infection. What is the recommendation or what have you seen regarding prophylactic antibiotics and genicular nerve block/RFA? Would you give this patient prophylactic abx? Thanks in advance.

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[lobelsteve]

None

 

[Ducttape]

your genicular is not in to the knee joint itself. there is no indication for need for antibiotics.

 

[Laryngospasm]

No indication

 

[Orin]

More over, that seems like a weak reason to avoid a replacement. Send her to an academic surgeon that does TKA revisions for a primary if indicated.

Proceed with the block and RFA as you normally would without antibiotics.

I would do Vanc if I was doing a PNS case on that.

 

[bedrock]

More over, that seems like a weak reason to avoid a replacement. Send her to an academic surgeon that does TKA revisions for a primary if indicated.

Proceed with the block and RFA as you normally would without antibiotics.

I would do Vanc if I was doing a PNS case on that.

Exactly.

I have seen many of these knees cases that were told by private docs that they "can't have a joint replacement due to infection risk" and the university will do a TKA no problem.

I would send to university. I try to avoid geniculars due to the terrible reimbursment. If they need it fine, but I'm not going out of my way looking for them.

 

[MitchLevi]

Pre TKA geniculars really aren't great for anyone. Patient and doctor.

Had a few homeruns, but on avg they don't take the place of a TKA.

 

[bedrock]

Pre TKA geniculars really aren't great for anyone. Patient and doctor.

Had a few homeruns, but on avg they don't take the place of a TKA.

agreed.

 

[Member10billion]

More over, that seems like a weak reason to avoid a replacement. Send her to an academic surgeon that does TKA revisions for a primary if indicated.

Proceed with the block and RFA as you normally would without antibiotics.

I would do Vanc if I was doing a PNS case on that.

An academic surgeon refused surgery on her. She prob needs it.

 

[Member10billion]

Pre TKA geniculars really aren't great for anyone. Patient and doctor.

Had a few homeruns, but on avg they don't take the place of a TKA.

Yeah. I'm still a fellow and have no control. Figured abx weren't needed, but I asked anyway bc I was told to. Also, my hospital is involved in a study determining efficacy of genicular nerve blocks and if it's related to # of lesions (something like that, I stopped caring since it's being managed by the rheumatology dept and they want us to do 9 separate lesions). So far, we are about 50-50 on results. Pending official results, tho!

 

[Member10billion]

Exactly.

I have seen many of these knees cases that were told by private docs that they "can't have a joint replacement due to infection risk" and the university will do a TKA no problem.

I would send to university. I try to avoid geniculars due to the terrible reimbursment. If they need it fine, but I'm not going out of my way looking for them.

this is a university

 

[MitchLevi]

Also, my hospital is involved in a study determining efficacy of genicular nerve blocks and if it's related to # of lesions (something like that, I stopped caring since it's being managed by the rheumatology dept and they want us to do 9 separate lesions).

LOL

 

[Orin]

this is a university

Send them to another. That sounds bush league.

Academic docs aren't always comfortable handling difficult cases, but this may be a good opportunity to discuss with an ortho resident/fellow/mid-level/faculty about why this patient is not a surgical candidate.

 

[deleted875186]

Maybe I’m an outlier, but I see no issue giving antibiotics if concerned, single dose before the injection. Can easily be justified.

Needles are going reasonably close to the edge of the joint capsule …. How would you know your not in the capsule? What’s the harm of a single dose of antibiotics? I haven’t looked at the literature, but I would venture to guess there is zero data on a situation like this, as genicular nerve block and RFA is relatively new. Joint infection is catastrophic. I hate geniculars with TKA hardware for this reason, I am paranoid about an infection.

 

[Baron Samedi]

Needles are going reasonably close to the edge of the joint capsule

I wanted to criticize this comment but then I thought about how often I see large joint effusions extent laterally in the suprapatellar recess under ultrasound when I do knee injections. I guess it's possible you could end up in there? 🤔

 

[Tboned]

Totally possible to get into joint capsule with a large effusion. Done it several times, joint fluid draining right on out

 

[cowboydoc]

Totally possible to get into joint capsule with a large effusion. Done it several times, joint fluid draining right on out

Same. Usually superior lateral.

 

[Tboned]

Same. Usually superior lateral.

Yes, I don’t think I’ve seen it other sites