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Published on: December 3, 2017
Fungal periprosthetic hip and knee joint infections clinical experience with a 2-stage treatment protocol
Konstantinos Anagnostakos1, Jens Kelm, Eduard Schmitt
1Klinik für Orthopädie und Orthopädische Chirurgie, Universitätskliniken des Saarlandes, Homburg/Saar, Germany.
Abstract:
Fungal periprosthetic joint infections are a rare entity in orthopedic surgery, and there exist no guidelines according to which these infections can be successfully managed. Between 2004 and 2009, 7 patients with fungal periprosthetic joint infections (4 total hip arthroplasties and 3 total knee arthroplasties) have been treated with a 2-stage protocol and implantation of antibiotic-loaded cement spacers. Most of the infection was caused by Candida species. Systemic antifungal agents were administered for 6 weeks in 6 cases and 6 months in 1 case. The mean spacer implantation time was 12 weeks. At a mean follow-up of 28 months (5-70 months), no persistence of infection or reinfection could be observed. A 2-stage treatment protocol with implantation of an antibiotic-loaded cement spacer is an efficient option in the treatment of fungal periprosthetic infections.
Insights
This study shows a two-stage treatment protocol using antibiotic-loaded cement spacers is effective for managing rare fungal periprosthetic joint infections, with no recurrence observed in treated patients.
Area of Science:
- Orthopedic Surgery
- Mycology
- Infectious Diseases
Background:
- Fungal periprosthetic joint infections (PJI) are uncommon complications following orthopedic procedures.
- Current management guidelines for fungal PJI are lacking, posing treatment challenges.
Purpose of the Study:
- To evaluate the efficacy of a two-stage treatment protocol using antibiotic-loaded cement spacers for fungal PJI.
- To assess the outcomes of this protocol in patients with hip and knee arthroplasties.
Main Methods:
- A retrospective review of 7 patients with fungal PJI treated between 2004 and 2009.
- All patients underwent a two-stage protocol involving antibiotic-loaded cement spacers.
- Systemic antifungal agents were administered post-operatively.
Main Results:
- The study included 4 total hip arthroplasties and 3 total knee arthroplasties.
- Candida species were the most common causative agents.
- Mean spacer implantation duration was 12 weeks.
- At a mean follow-up of 28 months, no infection persistence or reinfection was noted.
Conclusions:
- A two-stage treatment protocol with antibiotic-loaded cement spacers is an effective strategy for managing fungal PJI.
- This approach demonstrates successful outcomes in patients with infected hip and knee arthroplasties.
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