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Published on: December 3, 2017
Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty
Shih-Hui Peng1,2,3, Sheng-Hsun Lee1,2,3, Chun-Chieh Chen1,2,3
1Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.
Purpose:
Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication of hip or knee joint arthroplasty. The experience for outcomes of NTMPJI treatment is still limited. The objective of this study was to investigate the outcome of hip or knee nontuberculous mycobacteria periprosthetic joint infection following treatment with two-stage exchange arthroplasty.
Material And Methods:
From 1995 to 2020, 12 patients with NTMPJI were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidity, microbiological data, treatment outcome and antibiotic formula in bone cement.
Results:
Mycobacterium abcessus (n = 6) and Mycobacterium chelonae (n = 2) constitute the majority of the cases. Five patients had early-onset PJIs and the other seven patients were late onset. The success rate of two-stage exchange arthroplasty was 66.7% (8 of 12). Three patients experienced infection relapse, and one patient had soft tissue compromise complication. Post-operative antibiotic therapy may not improve the success rate (4 of 6 cases, 66.7%). Based on in vitro study, the most commonly used effective antibiotic in bone cement spacer for nontuberculous mycobacteria was amikacin.
Conclusions:
nontuberculous mycobacteria is a rare cause of PJIs and should be suspected especially in relatively immunocompromised patients. Resection arthroplasty with staged reimplantation is the preferred approach. Prolonged post-operative antibiotic therapy before reimplantation may not improve the success rate. Delayed revision surgery may not be needed and can be performed once C-reactive protein level is normal after a drug holiday.
Insights
Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication. Two-stage exchange arthroplasty achieved a 66.7% success rate for NTMPJI, with amikacin proving effective in bone cement.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare but serious complication following hip or knee arthroplasty.
- Limited data exists on the optimal treatment strategies and outcomes for NTMPJI.
Purpose of the Study:
- To investigate the treatment outcomes of hip or knee NTMPJI using two-stage exchange arthroplasty.
- To identify factors influencing treatment success and effective antibiotic choices for NTMPJI.
Main Methods:
- Retrospective analysis of 12 patients with NTMPJI treated with two-stage exchange arthroplasty between 1995 and 2020.
- Collection and analysis of demographic data, comorbidities, microbiological findings, treatment outcomes, and antibiotic use in bone cement spacers.
- In vitro assessment of antibiotic efficacy in bone cement for NTMPJI.
Main Results:
- The overall success rate of two-stage exchange arthroplasty for NTMPJI was 66.7% (8 of 12 patients).
- Mycobacterium abscessus and Mycobacterium chelonae were the most common species identified.
- Amikacin demonstrated the highest efficacy in vitro for use in bone cement spacers against NTMPJI pathogens.
Conclusions:
- Two-stage exchange arthroplasty is a viable treatment option for NTMPJI, particularly in immunocompromised patients.
- Prolonged postoperative antibiotic therapy may not significantly improve success rates.
- Resection arthroplasty with staged reimplantation is the preferred approach, and revision surgery timing can be guided by inflammatory markers.
