Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection Following Total Hip or Knee Arthroplasty Is Associated With High Attrition Rate and Mortality

2020 ◽  
Vol 35 (5) ◽  
pp. 1384-1389 ◽  
Author(s):  
Cameron B. Barton ◽  
David L. Wang ◽  
Qiang An ◽  
Timothy S. Brown ◽  
John J. Callaghan ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Attrition Rate ◽  
Two Stage ◽  
Total Hip ◽  
Exchange Arthroplasty ◽  
High Attrition Rate

Two-Stage Exchange Arthroplasty Is a Favorable Treatment Option Upon Diagnosis of a Fungal Periprosthetic Joint Infection

2018 ◽  
Vol 33 (11) ◽  
pp. 3555-3560 ◽  
Author(s):  
Feng-Chih Kuo ◽  
Karan Goswami ◽  
Noam Shohat ◽  
Kier Blevins ◽  
Alexander J. Rondon ◽  
...  
Keyword(s):  
Treatment Option ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Exchange Arthroplasty

A Case of Periprosthetic Joint Infection Because of Rothia Mucilaginosa

2021 ◽  
Author(s):  
Janse T Schermerhorn ◽  
Donald F Colantonio ◽  
Derek T Larson ◽  
Robert J McGill
Keyword(s):  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Diagnostic Delay ◽  
Infectious Agent ◽  
Two Stage ◽  
Treatment Regimens ◽  
History Of ◽  
Rothia Mucilaginosa ◽  
One Year

ABSTRACT Periprosthetic joint infection (PJI) is a rare but devastating complication of total joint arthroplasty. Identifying the offending infectious agent is essential to appropriate treatment, and uncommon pathogens often lead to a diagnostic delay. This case describes the first known instance of a total knee arthroplasty (TKA) with Rothia mucilaginosa, a typical respiratory tract organism. This report aims to provide insight into the treatment of this atypical PJI, as there are only six previously published cases of Rothia species PJI septic arthritis. The patient is a 64-year-old diabetic male who underwent a right TKA and left TKA ∼6 months later. Approximately 3 weeks status post-left TKA, he showed evidence of left PJI. One year after treatment and recovery from his left PJI, he presented with several months of right knee pain and fatigue. Subsequent labs and imaging revealed right PJI. No recent history of dental disease or work was observed. He then underwent two-stage revision right knee arthroplasty and microbial cultures yielded Rothia mucilaginosa. After initial empiric treatment, antibiotic therapy was narrowed to 6 weeks of vancomycin. Following negative aspiration cultures the patient underwent reimplantation of right TKA components. One year following treatment, the patient was fully recovered with no evidence of infection. This case emphasizes the possibility of microbial persistence despite various antibiotic treatment regimens for the patient’s contralateral knee arthroplasty and PJI. Additionally, this case demonstrates the importance of two-stage revision in patients with PJI, and the viability of treating Rothia species PJIs with vancomycin.

Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: The Rate and Reason for the Attrition After the First Stage

2019 ◽  
Vol 34 (11) ◽  
pp. 2749-2756 ◽  
Author(s):  
Qiaojie Wang ◽  
Karan Goswami ◽  
Feng-Chih Kuo ◽  
Chi Xu ◽  
Timothy L. Tan ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Exchange Arthroplasty

The treatment of periprosthetic joint infection: safety and efficacy of two stage versus one stage exchange arthroplasty

2020 ◽  
Vol 17 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Joseph R. Palmer ◽  
Tejbir S. Pannu ◽  
Jesus M. Villa ◽  
Jorge Manrique ◽  
Aldo M. Riesgo ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Stage Versus ◽  
Two Stage ◽  
Safety And Efficacy ◽  
One Stage ◽  
Exchange Arthroplasty

scholarly journals Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?

2022 ◽  
Author(s):  
A. C. Steinicke ◽  
J. Schwarze ◽  
G. Gosheger ◽  
B. Moellenbeck ◽  
T. Ackmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Rank Test ◽  
Success Rates ◽  
Two Stage ◽  
Second Stage ◽  
Exchange Arthroplasty ◽  
Parametric Testing

Abstract Introduction Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure. Materials and methods We retrospectively identified 55 patients (23 hips, 32 knees) who were treated with repeat resection arthroplasty and planned delayed reimplantation for recurrent periprosthetic joint infection between 2010 and 2019 after a prior two-stage revision at the same institution. The minimum follow-up was 12 months with a median follow-up time of 34 months (IQR 22–51). The infection-free survival, associated revision surgeries, and potential risk factors for further revision were analyzed using Kaplan–Meier survival curves and comparative non-parametric testing. Results 78% (43/55) underwent reimplantation after a repeat implant removal. Of those who completed the second-stage surgery, 37% (16/43) underwent additional revision for infection and 14% (6/55) underwent amputation. The reinfection-free implant survivorship amounted to 77% (95% CI 64–89%) after 1 year and 38% (95% CI 18–57%) after 5 years. Patients with a higher comorbidity score were less likely to undergo second-stage reimplantation (median 5 vs. 3, p = 0.034). Furthermore, obese patients (p = 0.026, Fisher’s exact test) and diabetics (p < 0.001, log-rank test) had a higher risk for further infection. Most commonly cultures yielded polymicrobial growth at the repeat two-stage exchange (27%, 15/55) and at re-reinfection (32%, 9/28). Pathogen persistence was observed in 21% (6/28) of re-reinfected patients. Conclusion The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.

scholarly journals Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis

2016 ◽  
Vol 14 (3) ◽  
pp. 529-536 ◽  
Author(s):  
Lingde Kong ◽  
Junming Cao ◽  
Yingze Zhang ◽  
Wenyuan Ding ◽  
Yong Shen
Keyword(s):  
Risk Factors ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Meta Analysis ◽  
Joint Infection ◽  
Total Hip

Fungal prosthetic joint infection in total hip or knee arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 589-595 ◽  
Author(s):  
C. Theil ◽  
T. Schmidt-Braekling ◽  
G. Gosheger ◽  
E. A. Idelevich ◽  
B. Moellenbeck ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Fungal Infections ◽  
Joint Infection ◽  
Treatment Success ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Total Hip ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Aims Fungal prosthetic joint infections (PJIs) are rare and account for about 1% of total PJIs. Our aim was to present clinical and microbiological results in treating these patients with a two-stage approach and antifungal spacers. Patients and Methods We retrospectively reviewed our institutional database and identified 26 patients with positive fungal cultures and positive Musculoskeletal Infection Society (MSIS) criteria for PJI who were treated between 2009 and 2017. We identified 18 patients with total hip arthroplasty (THA) and eight patients with total knee arthroplasty (TKA). The surgical and antifungal treatment, clinical and demographic patient data, complications, relapses, and survival were recorded and analyzed. Results The median follow-up was 33 months. The success rate was 38.5% (10/26). Fluconazole resistance was found in 15%. Bacterial co-infection was common in 44% of patients for THA and 66% of patients with TKA. Mortality, reoperations, and treatment failure were common complications. Conclusion Treatment with a two-stage exchange is a possible option for treatment, although fungal infections have a high failure rate. Therapeutic factors for treatment success remain unclear. Cite this article: Bone Joint J 2019;101-B:589–595.

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