The fate of fungal periprosthetic joint infection after total knee arthroplasty.
Humans
Arthroplasty, Replacement, Knee
/ adverse effects
Antifungal Agents
/ therapeutic use
Prosthesis-Related Infections
/ drug therapy
Retrospective Studies
Treatment Outcome
Arthritis, Infectious
/ surgery
Reoperation
/ adverse effects
Knee Joint
/ surgery
Knee Prosthesis
/ adverse effects
Anti-Bacterial Agents
/ therapeutic use
Antifungal treatment
Candida
Fungal periprosthetic joint infection
Total knee arthroplasty
Two-stage revision arthroplasty
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
received:
27
02
2023
accepted:
09
07
2023
medline:
27
10
2023
pubmed:
6
8
2023
entrez:
5
8
2023
Statut:
ppublish
Résumé
To demonstrate the clinical outcomes of patients with fungal periprosthetic joint infections (PJIs) after two-stage exchange arthroplasty combined with antifungal therapy. We retrospectively reviewed the outcomes of 41 patients with fungal PJIs after primary total knee arthroplasty (TKA) in a single centre from January 1999 to October 2017. During the first stage of resection arthroplasty, antifungal-impregnated cement spacers (AICSs) were implanted in all patients. After systemic antifungal treatment during the interval between the two surgeries, delayed reimplantation as part of a two-stage exchange protocol was performed when patients were clinically stable. We defined treatment success as a well-functioning arthroplasty without any signs of PJI after a minimum follow-up of two years without antimicrobial suppression. Successful treatment was confirmed by repeat negative cultures as well as a return of inflammatory markers to normal levels. The treatment success rate was 63.4% at the final follow-up. Thirty-six of 41 patients (87.8%) met the criteria for second-stage revision after confirmation of complete infection control. The mean prosthesis-free interval was 6.6 months (range, 2.0-30.0 months). During follow-up after two-stage exchange arthroplasty, ten patients (27.7% of 36 patients) unfortunately experienced recurrence or relapse of infection after an average of 31.3 months (range, 2.7-135.6 months). The rate of survivorship free from reinfection was 94.4% at six months, 84.8% at one year, and 73.6% at two years. Cox proportional hazard regression analysis demonstrated that the prosthesis-free interval (HR = 1.016, p = 0.037) and mean length of antifungal treatment (HR = 0.226, p = 0.046) were potential risk factors for failure. Fungal PJIs led to devastating clinical outcomes despite even two-stage revision arthroplasty with the use of AICSs and antifungal medications.
Identifiants
pubmed: 37542541
doi: 10.1007/s00264-023-05895-7
pii: 10.1007/s00264-023-05895-7
doi:
Substances chimiques
Antifungal Agents
0
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2727-2735Informations de copyright
© 2023. The Author(s) under exclusive licence to SICOT aisbl.
Références
Emmerson KP, Moran CG, Pinder IM (1996) Survivorship analysis of the Kinematic Stabilizer total knee replacement: a 10- to 14-year follow-up. J Bone Joint Surg Br 78:441–445
doi: 10.1302/0301-620X.78B3.0780441
pubmed: 8636183
Ranawat CS (2002) History of total knee replacement. J South Orthop Assoc 11:218–226
pubmed: 12597066
Kuzyk PR, Dhotar HS, Sternheim A, Gross AE, Safir O, Backstein D (2014) Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes. J Am Acad Orthop Surg 22:153–164
doi: 10.5435/JAAOS-22-03-153
pubmed: 24603825
Mahomed NN, Barrett J, Katz JN, Baron JA, Wright J, Losina E (2005) Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am 87:1222–1228
pubmed: 15930530
Azzam K, Parvizi J, Jungkind D, Hanssen A, Fehring T, Springer B et al (2009) Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg Am 91(Suppl 6):142–149
doi: 10.2106/JBJS.I.00574
pubmed: 19884422
Phelan DM, Osmon DR, Keating MR, Hanssen AD (2002) Delayed reimplantation arthroplasty for candidal prosthetic joint infection: a report of 4 cases and review of the literature. Clin Infect Dis 34:930–938
doi: 10.1086/339212
pubmed: 11880958
Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466:1710–1715
doi: 10.1007/s11999-008-0209-4
pubmed: 18421542
pmcid: 2505241
Kuo FC, Goswami K, Shohat N, Blevins K, Rondon AJ, Parvizi J (2018) Two-stage exchange arthroplasty is a favorable treatment option upon diagnosis of a fungal periprosthetic joint infection. J Arthroplasty 33:3555–3560
doi: 10.1016/j.arth.2018.07.024
pubmed: 30150154
Ueng SW, Lee CY, Hu CC, Hsieh PH, Chang Y (2013) What is the success of treatment of hip and knee candidal periprosthetic joint infection? Clin Orthop Relat Res 471:3002–3009
doi: 10.1007/s11999-013-3007-6
pubmed: 23633184
pmcid: 3734391
Nace J, Siddiqi A, Talmo CT, Chen AF (2019) Diagnosis and management of fungal periprosthetic joint infections. J Am Acad Orthop Surg 27:e804–e818
doi: 10.5435/JAAOS-D-18-00331
pubmed: 30520804
Jakobs O, Schoof B, Klatte TO, Schmidl S, Fensky F, Guenther D et al (2015) Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review. Orthop Rev (Pavia) 7:5623
pubmed: 25874061
Schoof B, Jakobs O, Schmidl S, Klatte TO, Frommelt L, Gehrke T et al (2015) Fungal periprosthetic joint infection of the hip: a systematic review. Orthop Rev (Pavia) 7:5748
pubmed: 25874063
Anagnostakos K, Kelm J, Schmitt E, Jung J (2012) Fungal periprosthetic hip and knee joint infections clinical experience with a 2-stage treatment protocol. J Arthroplasty 27:293–298
doi: 10.1016/j.arth.2011.04.044
pubmed: 21752583
Baecker H, Frieler S, Geßmann J, Pauly S, Schildhauer TA, Hanusrichter Y (2021) Three-stage revision arthroplasty for the treatment of fungal periprosthetic joint infection: outcome analysis of a novel treatment algorithm: a prospective study. Bone Jt Open 2:671–678
doi: 10.1302/2633-1462.28.BJO-2021-0002.R2
pubmed: 34406077
pmcid: 8384437
Brown TS, Petis SM, Osmon DR, Mabry TM, Berry DJ, Hanssen AD et al (2018) Periprosthetic joint infection with fungal pathogens. J Arthroplasty 33:2605–2612
doi: 10.1016/j.arth.2018.03.003
pubmed: 29636249
Hwang BH, Yoon JY, Nam CH, Jung KA, Lee SC, Han CD et al (2012) Fungal peri-prosthetic joint infection after primary total knee replacement. J Bone Joint Surg Br 94:656–659
doi: 10.1302/0301-620X.94B5.28125
pubmed: 22529086
Kim JK, Lee DY, Kang DW, Ro DH, Lee MC, Han HS (2018) Efficacy of antifungal-impregnated cement spacer against chronic fungal periprosthetic joint infections after total knee arthroplasty. Knee 25:631–637
doi: 10.1016/j.knee.2018.04.004
pubmed: 29778657
Merrer J, Dupont B, Nieszkowska A, De Jonghe B, Outin H (2001) Candida albicans prosthetic arthritis treated with fluconazole alone. J Infect 42:208–209
doi: 10.1053/jinf.2001.0819
pubmed: 11545555
Theil C, Schmidt-Braekling T, Gosheger G, Idelevich EA, Moellenbeck B, Dieckmann R (2019) Fungal prosthetic joint infection in total hip or knee arthroplasty: a retrospective single-centre study of 26 cases. Bone Joint J 101(5):589–595
doi: 10.1302/0301-620X.101B5.BJJ-2018-1227.R2
pubmed: 31038988
Wu MH, Hsu KY (2011) Candidal arthritis in revision knee arthroplasty successfully treated with sequential parenteral-oral fluconazole and amphotericin B-loaded cement spacer. Knee Surg Sports Traumatol Arthrosc 19:273–276
doi: 10.1007/s00167-010-1211-4
pubmed: 20652534
Wyman J, McGough R, Limbird R (2002) Fungal infection of a total knee prosthesis: successful treatment using articulating cement spacers and staged reimplantation. Orthopedics 25:1391–1394 discussion 1394
doi: 10.3928/0147-7447-20021201-19
pubmed: 12502204
Fusini F, Aprato A, Massè A, Bistolfi A, Girardo M, Artiaco S (2020) Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes. Int Orthop 44:15–22
doi: 10.1007/s00264-019-04369-z
pubmed: 31254016
Koutserimpas C, Zervakis SG, Maraki S, Alpantaki K, Ioannidis A, Kofteridis DP et al (2019) Non-albicans Candida prosthetic joint infections: a systematic review of treatment. World J Clin Cases 7:1430–1443
doi: 10.12998/wjcc.v7.i12.1430
pubmed: 31363471
pmcid: 6656666
Kuiper JW, van den Bekerom MP, van der Stappen J, Nolte PA, Colen S (2013) 2-stage revision recommended for treatment of fungal hip and knee prosthetic joint infections. Acta Orthop 84:517–523
doi: 10.3109/17453674.2013.859422
pubmed: 24171675
pmcid: 3851663
Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ et al (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469:2992–2994
doi: 10.1007/s11999-011-2102-9
pubmed: 21938532
pmcid: 3183178
Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:e1–e25
doi: 10.1093/cid/cis803
pubmed: 23223583
Gebauer M, Frommelt L, Achan P, Board TN, Conway J, Griffin W et al (2014) Management of fungal or atypical periprosthetic joint infections. J Arthroplasty 29:112–114
doi: 10.1016/j.arth.2013.09.049
pubmed: 24360494
Haleem AA, Berry DJ, Hanssen AD (2004) Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000147713.64235.7335-39
Sanguinetti M, Posteraro B, Lass-Flörl C (2015) Antifungal drug resistance among Candida species: mechanisms and clinical impact. Mycoses 58(Suppl 2):2–13
doi: 10.1111/myc.12330
pubmed: 26033251
Yang SH, Pao JL, Hang YS (2001) Staged reimplantation of total knee arthroplasty after Candida infection. J Arthroplasty 16:529–532
doi: 10.1054/arth.2001.21458
pubmed: 11402423
Gebauer M, Frommelt L, Achan P, Board TN, Conway J, Griffin W et al (2014) Management of fungal or atypical periprosthetic joint infections. J Orthop Res 32(Suppl 1):S147–S151
pubmed: 24464889
Karczewski D, Ren Y, Andronic O, Akgün D, Perka C, Müller M et al (2022) Candida periprosthetic joint infections - risk factors and outcome between albicans and non-albicans strains. Int Orthop 46:449–456
doi: 10.1007/s00264-021-05214-y
pubmed: 34783888
Tsui C, Kong EF, Jabra-Rizk MA (2016) Pathogenesis of Candida albicans biofilm. Pathog Dis 74:ftw018
doi: 10.1093/femspd/ftw018
pubmed: 26960943
pmcid: 5975230
Pannanusorn S, Fernandez V, Römling U (2013) Prevalence of biofilm formation in clinical isolates of Candida species causing bloodstream infection. Mycoses 56:264–272
doi: 10.1111/myc.12014
pubmed: 23113805
Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr et al (2009) Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 48:503–535
doi: 10.1086/596757
pubmed: 19191635
Sidhu MS, Cooper G, Jenkins N, Jeys L, Parry M, Stevenson JD (2019) Prosthetic fungal infections: poor prognosis with bacterial co-infection. Bone Joint J 101(5):582–588
doi: 10.1302/0301-620X.101B5.BJJ-2018-1202.R1
pubmed: 31039037
Cobo F, Rodríguez-Granger J, López EM, Jiménez G, Sampedro A, Aliaga-Martínez L et al (2017) Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report. Infect Dis (Lond) 49:81–94
doi: 10.1080/23744235.2016.1219456
pubmed: 27586845