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Published on: December 3, 2017
Mycobacterial periprosthetic joint infection after primary total knee arthroplasty
Bo-Hyun Hwang1,2, Su-Chan Lee3, Alvin Ong4
1Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul, 07999, Republic of Korea.
Purpose:
Mycobacterial periprosthetic joint infection (PJI) is very rare and is generally associated with an immunosuppressive environment. Few large-scale studies of this unusual PJI have been conducted. The current study was performed to assess the clinical features and outcomes following two-stage re-implantation for mycobacterial PJI after primary total knee arthroplasty (TKA).
Methods:
We conducted a retrospective review of data collected from our database involving ten cases of two-stage re-implantation manifesting mycobacterial PJI. Patients were followed for at least five years or until recurrent infection. The mean follow-up duration in patients who remained free of infection was 7.5 years (range 5-9.5 years).
Results:
Seven patients (70%) belonged to the American Society of Anesthesiologists' grade 3 or 4. The surgical protocol entailed resection arthroplasty and cement spacer insertion with vigorous debridement, followed by at least six weeks of systemic antimicrobial therapy and delayed re-implantation in all patients. The median duration from resection arthroplasty to re-implantation was 5.3 months (range 2-10.5 months). Following re-implantation, five patients with Mycobacterium fortuitum were treated with amikacin for six weeks and oral clarithromycin for three months. Five patients infected with M. tuberculosis received anti-tuberculosis medications immediately after pathogen isolation, for a period of 12 months.
Conclusion:
Mycobacterial PJI can be treated successfully via resection arthroplasty and delayed re-implantation combined with proper antimicrobial agents. Suspicious infection or loosening after primary TKA, particularly in an immunosuppressive environment, warrants the attention of an orthopedic surgeon to consider the possibility of unusual PJI.
Insights
Mycobacterial periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) can be successfully treated with resection arthroplasty and delayed re-implantation. This two-stage approach, combined with appropriate antimicrobial therapy, offers a viable solution for this rare complication.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Mycobacterial periprosthetic joint infection (PJI) is a rare complication following total knee arthroplasty (TKA).
- It is often associated with an immunosuppressive patient environment.
- Large-scale studies on mycobacterial PJI are scarce.
Purpose of the Study:
- To assess the clinical features and outcomes of two-stage re-implantation for mycobacterial PJI.
- To evaluate the efficacy of this surgical approach in patients with primary TKA.
Main Methods:
- Retrospective review of ten cases of two-stage re-implantation for mycobacterial PJI.
- Patients were followed for at least five years or until recurrent infection.
- Surgical protocol included resection arthroplasty, cement spacer insertion, debridement, and delayed re-implantation after antimicrobial therapy.
Main Results:
- Seven out of ten patients (70%) had an American Society of Anesthesiologists' grade of 3 or 4.
- The median time from resection arthroplasty to re-implantation was 5.3 months.
- Successful outcomes were achieved with specific antimicrobial regimens based on the Mycobacterium species (M. fortuitum or M. tuberculosis).
Conclusions:
- Mycobacterial PJI can be successfully treated with resection arthroplasty and delayed re-implantation.
- Appropriate antimicrobial agents are crucial for successful treatment outcomes.
- Orthopedic surgeons should consider unusual PJI in cases of suspicious infection or loosening after TKA, especially in immunosuppressed patients.
