27 Diagnosis of Periprosthetic Joint Infection After Total Knee Replacement

Background: The patients can undergo total knee replacement surgery either under general anaesthesia, combined spinal and epidural anaesthesia, nerve root block, spinal combined with intra-articular knee cocktail. There is an ongoing debate amongst Arthroplasty surgeons whether to include steroid in the cocktail or not. The aim of this study is to assess whether there is an added benefit of including steroid in the intraarticular mixture.Methods: This prospective study was conducted at Sri Ramachandra Institute of Higher education, Chennai between December 2017 to December 2018. The study was conducted in the Arthroplasty unit, Department of Orthopaedics. SRIHER ethics committee clearance was obtained prior to the start of the study. The inclusion criteria were patients who underwent total knee replacement surgery under combined spinal and intra-articular knee cocktail. Patients were divided into two groups based on the use of steroid in the intra-articular mixture. Patients were evaluated using Visual analogue scale, opioids usage as primary endpoint while any joint infection within six months of the surgery and knee society score at 1 month and 6 months as the secondary endpoint.Results: The mean visual analogue score for the 0 pod for the group I and group II were 2.3 and 2.4 respectively. There was no case of infection in both groups.Conclusions: There is no fringe benefit of adding steroid to the knee cocktail. So it is not obligatory to add steroid in intra-articular total knee arthroplasty cocktail.

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Fungal Prosthetic Joint Infection Following Total Knee Arthroplasty: A Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i02.2042 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Baraa W Mafrachi ◽

Ashraf H Al Debei ◽

Farah M Al Muhtaseb ◽

Jihad M Al Ajlouni ◽

Yazan S Hammad

Keyword(s):

Total Knee Arthroplasty ◽

Case Report ◽

Total Knee Replacement ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Rare Complication ◽

Joint Infection ◽

Prosthetic Joint ◽

Total Knee

Introduction: Prosthetic joint infection (PJI) is a rare complication of total knee replacement (TKR), yet it is a serious and debilitating condition. Bacterial infection accounts for the majority of cases and fungal infection is estimated to cause 1% of all prosthesis infection. Case Report: This case presents a 60years female, who presented to our outpatient orthopedic clinic complaining of right knee pain, swelling, and hotness. The physical examination revealed redness, hotness, restricted range of movement, and tibial loosening, 9 months following TKR revision. Culture of the joint aspirate showed growth of “Candida parapsilosis” and second aspirate confirmed the diagnosis. The patient then underwent two stages revision surgery with placement of amphotericin B loaded cement, to maintain high local antifungal concentration in addition to decrease the side effects of amphotericinB infusion such as thrombophlebitis and the more serious systemic effect as nephrotoxicity. The post-operative course was uneventful, with gradual improvement and restoration of normal movement range. Conclusion: Fungal PJI is a rare complication of TKR, yet it results in severe debilitating symptoms and impairment of the patient functional capacity. Careful evaluation of the patient followed by a detailed workup is necessary for the identification of the underlying causative micro-organism. Two-stage revision surgery with antifungal loaded cement spacer and antifungal therapy currently is the standard of management. To the best of our knowledge, this is the first fungal PJI following total knee arthroplasty reported in Jordan. Keywords: Fungal prosthetic joint infection, fungal infection, total knee replacement, total knee replacement complication.

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