Abiotrophia defectiva as a Rare Causative Agent of Periprosthetic Total Knee Arthroplasty Infections: A Case Report and Literature Review

AbstractWe present a case of Abiotrophia defectiva in a prosthetic knee infection following total knee replacement for the first time. A 69-year-old female was prediagnosed with prosthetic knee infection, and a two-stage revision arthroplasty was applied. A. defectiva was cultured by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) from the synovial fluid aspirates. Penicillin G and gentamicin had been administered. One year postoperatively, a scintigraphy showed no recurrence. A. defectiva may be missed in culture negative patients with knee or hip arthroplasty. They should be carefully evaluated if they have undergone recent dental procedures.

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Drug Reaction with Eosinophilia and Systemic Syndrome in Revision Arthroplasty for a Prosthetic Knee Infection

JBJS Case Connector ◽

10.2106/jbjs.cc.20.00805 ◽

2021 ◽

Vol 11 (2) ◽

pp. e20.00805

Author(s):

Daniel A. Portney ◽

Hayden P. Baker ◽

Margaret M. Boyle ◽

Victoria H. Barbosa ◽

Hue H. Luu

Keyword(s):

Drug Reaction ◽

Revision Arthroplasty ◽

Knee Infection ◽

Prosthetic Knee ◽

Prosthetic Knee Infection

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Acute Infection in Total Knee Arthroplasty: Diagnosis and Treatment

The Open Orthopaedics Journal ◽

10.2174/1874325001307010197 ◽

2013 ◽

Vol 7 (1) ◽

pp. 197-204 ◽

Cited By ~ 19

Author(s):

Juan Carlos Martínez-Pastor ◽

Francisco Maculé-Beneyto ◽

Santiago Suso-Vergara

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Acute Infection ◽

Septic Complication ◽

Two Stage ◽

Revision Process ◽

Knee Infection ◽

Prosthetic Knee ◽

Total Knee ◽

Prosthetic Knee Infection

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series.For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology,Staphylococcus aureusand coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%).Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs.The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors.

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Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention

Frontiers in Surgery ◽

10.3389/fsurg.2021.551814 ◽

2021 ◽

Vol 8 ◽

Author(s):

Florian Bourbotte-Salmon ◽

Tristan Ferry ◽

Mickaël Cardinale ◽

Elvire Servien ◽

Frédéric Rongieras ◽

...

Keyword(s):

Knee Arthroplasty ◽

Functional Outcomes ◽

Knee Prosthesis ◽

Implant Removal ◽

Knee Infection ◽

Prosthetic Knee ◽

Rotating Hinge ◽

Total Knee ◽

Prosthetic Knee Infection

Introduction: Management of chronic infection following total knee arthroplasty (TKA) is challenging. Rotating hinged prostheses are often required in this setting due to severe bone loss, ligamentous insufficiency, or a combination of the two. The nature of the mechanical and septic complications occurring in this setting has not been well-described. The aim of this study was to evaluate patient outcomes using a hinge knee prosthesis for prosthetic knee infections and to investigate risk factors for implant removal.Methods: This was a retrospective cohort study that included all patients treated in our tertiary level referral center between January 2009 and December 2016 for prosthetic knee infection with a hinge knee prosthesis. Only patients with a minimum 2-year of follow-up were included. Functional evaluation was performed using international knee society (IKS) “Knee” and “Function” scores. Survival analysis comparing implant removal risks for mechanical and septic causes was performed using Cox univariate analysis and Kaplan-Meier curves. Risk factors for implant removal and septic failure were assessed.Results: Forty-six knees were eligible for inclusion. The majority of patients had satisfactory functional outcomes as determined by mean IKS scores (mean knee score: 70.53, mean function score: 46.53 points, and mean knee flexion: 88.75°). The 2-year implant survival rate was 89% but dropped to 65% at 7 years follow-up. The risk of failure (i.e., implant removal) was higher for septic etiology compared to mechanical causes. Patients with American society of anesthesiologists (ASA) score>1, immunosuppression, or with peripheral arterial diseases had a higher risk for septic failure. Patients with acute infection according to the Tsukayamaclassification had a higher risk of failure. Of the 46 patients included, 19 (41.3%) had atleast one infectious event on the surgical knee and most of these were superinfections (14/19) with new pathogens isolated. Among pathogens responsible for superinfections (i) cefazolin and gentamicin were both active in six of the cases but failed to prevent the superinfection; (ii) cefazolin and/or gentamicin were not active in eight patients, leading to alternative systemic and/or local antimicrobial prophylaxis consideration.Conclusions: Patients with chronic total knee arthroplasty (TKA) infection, requiring revision using rotating hinge implant, had good functional outcomes but experienced a high rate of septic failure, mostly due to bacterial superinfection. These patients may need optimal antimicrobial systemic prophylaxis and innovative approaches to reduce the rate of superinfection.

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Phage Therapy for Limb-threatening Prosthetic Knee Klebsiella pneumoniae Infection: Case Report and In Vitro Characterization of Anti-biofilm Activity

Clinical Infectious Diseases ◽

10.1093/cid/ciaa705 ◽

2020 ◽

Cited By ~ 9

Author(s):

Edison J Cano ◽

Katherine M Caflisch ◽

Paul L Bollyky ◽

Jonas D Van Belleghem ◽

Robin Patel ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Klebsiella Pneumoniae ◽

Knee Arthroplasty ◽

Phage Therapy ◽

Knee Infection ◽

Prosthetic Knee ◽

Satisfactory Outcome ◽

Total Knee ◽

Prosthetic Knee Infection

Abstract Background Prosthetic joint infection (PJI) is a potentially limb-threatening complication of total knee arthroplasty. Phage therapy is a promising strategy to manage such infections including those involving antibiotic-resistant microbes, and to target microbial biofilms. Experience with phage therapy for infections associated with retained hardware is limited. A 62-year-old diabetic man with a history of right total knee arthroplasty 11 years prior who had suffered multiple episodes of prosthetic knee infection despite numerous surgeries and prolonged courses of antibiotics, with progressive clinical worsening and development of severe allergies to antibiotics, had been offered limb amputation for persistent right prosthetic knee infection due to Klebsiella pneumoniae complex. Intravenous phage therapy was initiated as a limb-salvaging intervention. Methods The patient received 40 intravenous doses of a single phage (KpJH46Φ2) targeting his bacterial isolate, alongside continued minocycline (which he had been receiving when he developed increasing pain, swelling, and erythema prior to initiation of phage therapy). Serial cytokine and biomarker measurements were performed before, during, and after treatment. The in vitro anti-biofilm activity of KpJH46Φ2, minocycline and the combination thereof was evaluated against a preformed biofilm of the patient’s isolate and determined by safranin staining. Results Phage therapy resulted in resolution of local symptoms and signs of infection and recovery of function. The patient did not experience treatment-related adverse effects and remained asymptomatic 34 weeks after completing treatment while still receiving minocycline. A trend in biofilm biomass reduction was noted 22 hours after exposure to KpJH46Φ2 (P = .063). The addition of phage was associated with a satisfactory outcome in this case of intractable biofilm-associated prosthetic knee infection. Pending further studies to assess its efficacy and safety, phage therapy holds promise for treatment of device-associated infections.

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Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

Modern Rheumatology ◽

10.3109/s10165-010-0331-5 ◽

2010 ◽

Vol 20 (6) ◽

pp. 627-631 ◽

Cited By ~ 3

Author(s):

Arata Nakajima ◽

Ryutaku Kaneyama ◽

Hitoshi Watanabe ◽

Masazumi Murakami ◽

Koichi Nakagawa ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Infection ◽

Acupuncture Needle ◽

Prosthetic Knee ◽

Total Knee ◽

Prosthetic Knee Infection

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Image-guided in situ detection of bacterial biofilms in a human prosthetic knee infection model: a feasibility study for clinical diagnosis of prosthetic joint infections

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-020-04982-w ◽

2020 ◽

Author(s):

Jorrit W. A. Schoenmakers ◽

Marjolein Heuker ◽

Marina López-Álvarez ◽

Wouter B. Nagengast ◽

Gooitzen M. van Dam ◽

...

Keyword(s):

Optical Imaging ◽

Bacterial Species ◽

Bacterial Biofilms ◽

Infection Model ◽

Knee Infection ◽

Prosthetic Knee ◽

Image Guided ◽

Prosthetic Joints ◽

Prosthetic Joint Infections ◽

Prosthetic Knee Infection

Abstract Purpose Due to an increased human life expectancy, the need to replace arthritic or dysfunctional joints by prosthetics is higher than ever before. Prosthetic joints are unfortunately inherently susceptible to bacterial infection accompanied by biofilm formation. Accurate and rapid diagnosis is vital to increase therapeutic success. Yet, established diagnostic modalities cannot directly detect bacterial biofilms on prostheses. Therefore, the present study was aimed at investigating whether arthroscopic optical imaging can accurately detect bacterial biofilms on prosthetic joints. Methods Here, we applied a conjugate of the antibiotic vancomycin and the near-infrared fluorophore IRDye800CW, in short vanco-800CW, in combination with arthroscopic optical imaging to target and visualize biofilms on infected prostheses. Results We show in a human post-mortem prosthetic knee infection model that a staphylococcal biofilm is accurately detected in real time and distinguished from sterile sections in high resolution. In addition, we demonstrate that biofilms associated with the clinically most relevant bacterial species can be detected using vanco-800CW. Conclusion The presented image-guided arthroscopic approach provides direct visual diagnostic information and facilitates immediate appropriate treatment selection.

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