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Missed Diagnosis of Septic Knee

Missed Diagnosis of Septic Knee

Case Summary

The patient in this case was having knee pain, so she went to the local clinic for treatment. After taking X-rays, the doctor (a Family Practitioner) advised the patient that she had arthritis and subsequently gave her steroid injections in the knee. The knee pain continued to worsen, so she went back to the clinic. This time she was seen by a different doctor and he reportedly advised her that the imaging taken by the defendant showed an infection in her knee. This doctor allegedly attributed her pain and the spread of the infection, to the defendant’s injection in the knee (at the first appointment). The patient has since undergone a series of treatments for the infection.


Did the X-ray reveal infection prior to the injection? If it did, did the defendant breach the Standard of Care when he administered a steroid injection in the patient’s knee? Do any other potential claims exist?

Expert Findings

AMFS expert (Orthopedic Surgery) reviewed this case matter and provided the following opinion: This case appears to have merit. The most likely scenario is that the patient had a septic knee upon original presentation. The patient was evaluated and given a steroid injection. No aspiration was done and vital signs were not obtained (or at least a temperature was not recorded). The patient worsened over the ensuing few days. She was seen again and an MRI was ordered. Eventually, the patient presented with what appeared to be obvious sepsis of the knee and only at that time was the patient referred to orthopedic surgery. Orthopedic surgeons appear to have taken excellent care of the patient – they immediately aspirated the knee and took the patient to surgery for washout. There was a subsequent washout; the patient was treated on IV antibiotics. Unfortunately, it appears that the patient ended up with significant sequelae from the infection. The patient did lose range of motion. It has been proposed that possibly an infection was introduced via the steroid injection itself. Although this is possible, I think it is less likely than the scenario in which the patient presented originally with a septic knee.

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