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Published on: December 3, 2017
Two-Stage Treatment Protocol of Fungal Periprosthetic Hip and Knee Joint Infections: the Clinical Experience from a
1Department of Orthopaedics, Changzhou Traditional Chinese medical hospital, affi liated to Nanjing University of Traditional Chinese Medicine, Changzhou, Jiangsu Province, China.
Purpose Of The Study:
To evaluate the clinical results and safety of fungal periprosthetic joint Infections (fPJIs) using two-stage treatment protocol.
Material And Methods:
8 patients with fPJIs (3 hips and 5 knees) using two-stage revision were reviewed retrospectively and followed up at least 2 years. The preoperative demographic data, two-stage treatment protocol, results of microbiology and histologic workup and postoperative follow-up results (reimplantation success rate and infection free time) were recorded.
Results:
7 patients got successful reimplantation, with a 75% reimplantation success rate. Two patients got knee arthrodesis eventually. All patients were infection free with a median follow-up of 4.0 ± 2.0 years (range, 2-7 years). Of them, Candida species were found in 7 patients, while non-Candida specimen was only isolated in 1 patient with Aspergillus. Only 2 patients had coexisting bacterial infection (Methicillin-resistant coagulase-negative Staphylococci and Proteus mirabilis respectively). The average interval between the initial surgery and diagnosis of fPJIs was 21.50±34.79 months (range, 4-104 months). The mean time of spacer implantation was 7.75±2.77 months (range, 6-14 months). None serious complication or above knee amputation was found.
Discussion:
fPJIs are very rare and considerable challenge after total hip or knee arthroplasty. The goal of therapy is to eradicate local infection and maintain function. Candida species were the most common pathogen. The duration between spacer placement and staged reimplantation was highly variable, and generally dependent upon the results of joint aspirates and infl ammatory markers. The current study shows that the two-stage treatment protocol is recommended for fungal periprosthetic hip and knee joint infections.
Conclusions:
The two-stage treatment protocol is recommended for fungal periprosthetic hip and knee joint infections. The safety and effi cacy of biantibiotical impregnated (antifungal + antibiotics) cement spacer is confi rmed. Further evidence-based work is needed to determine the optimal drug dose and reimplantation time.
Key Words:
two-stage treatment protocol, fungal periprosthetic infections, hip spacer, knee spacer.
Insights
The two-stage treatment protocol is effective for treating fungal periprosthetic joint infections (fPJIs), achieving a high reimplantation success rate and keeping patients infection-free. This method is recommended for managing these challenging hip and knee infections.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Mycology
Background:
- Fungal periprosthetic joint infections (fPJIs) are rare but pose a significant challenge after total hip or knee arthroplasty.
- Effective management strategies are crucial for eradicating infection and restoring joint function.
Purpose of the Study:
- To evaluate the clinical outcomes and safety of a two-stage treatment protocol for fungal periprosthetic joint infections (fPJIs).
Main Methods:
- Retrospective review of 8 patients (3 hips, 5 knees) with fPJIs treated with a two-stage revision protocol.
- Data collected included demographics, treatment details, microbiology, histology, and postoperative follow-up (reimplantation success, infection-free time).
Main Results:
- A 75% reimplantation success rate was achieved in 7 out of 8 patients, with a median follow-up of 4 years.
- All patients remained infection-free; Candida species were the most common fungal pathogens identified.
- No serious complications or amputations occurred, and the interval between initial surgery and fPJIs diagnosis was variable.
Conclusions:
- The two-stage treatment protocol is a recommended and safe approach for managing fungal periprosthetic hip and knee joint infections.
- Bi-antibiotical (antifungal + antibiotic) impregnated cement spacers demonstrated safety and efficacy.
- Further research is needed to optimize drug dosage and timing for reimplantation.
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