Failure After 2-Stage Exchange Arthroplasty for Treatment of Periprosthetic Joint Infection: The Role of Antibiotics in the Cement Spacer

Managing substantial proximal and/or distal femoral bone defects is one of the biggest challenges in chronic hip periprosthetic joint infection. Most authors use two-stage arthroplasty with a temporary antibiotic-loaded cement spacer for the management of these patients. In this study, we show our experience with one-stage exchange arthroplasty in managing severe bone defects due to radiological-extensive proximal femoral osteomyelitis. Two patients were included in the study. They showed radiological-extensive proximal femoral osteomyelitis, and they were treated with one-stage exchange arthroplasty using megaprosthesis. Diffuse osteomyelitis was confirmed in both cases; in one case, the histology was compatible with osteomyelitis, and the other case had a positive culture identified in a bone sample. At a minimum of a four-year follow-up, the patients did not reveal any clinical, radiological or laboratory signs of infection. In conclusion, one-stage exchange arthroplasty and megaprosthesis is an option for the treatment of chronic hip periprosthetic joint infection associated with radiological-diffuse proximal femoral osteomyelitis.

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Evidence of MRSE on a gentamicin and vancomycin impregnated polymethyl-methacrylate (PMMA) bone cement spacer after two-stage exchange arthroplasty due to periprosthetic joint infection of the knee

BMC Infectious Diseases ◽

10.1186/1471-2334-14-144 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 26

Author(s):

Jan Schmolders ◽

Gunnar TR Hischebeth ◽

Max J Friedrich ◽

Thomas M Randau ◽

Matthias D Wimmer ◽

...

Keyword(s):

Bone Cement ◽

Polymethyl Methacrylate ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Cement Spacer ◽

Two Stage ◽

Exchange Arthroplasty ◽

Pmma Bone Cement

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Candida Periprosthetic Joint Infection: Is It Curable?

Antibiotics ◽

10.3390/antibiotics10040458 ◽

2021 ◽

Vol 10 (4) ◽

pp. 458

Author(s):

Laura Escolà-Vergé ◽

Dolors Rodríguez-Pardo ◽

Pablo S. Corona ◽

Carles Pigrau

Keyword(s):

Medical Devices ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Antifungal Treatment ◽

Cement Spacer ◽

Candida Spp ◽

Best Management ◽

High Quality Evidence ◽

Patients At Risk ◽

Quality Evidence

Candida periprosthetic joint infection (CPJI) is a rare and very difficult to treat infection, and high-quality evidence regarding the best management is scarce. Candida spp. adhere to medical devices and grow forming biofilms, which contribute to the persistence and relapse of this infection. Typically, CPJI presents as a chronic infection in a patient with multiple previous surgeries and long courses of antibiotic therapy. In a retrospective series of cases, the surgical approach with higher rates of success consists of a two-stage exchange surgery, but the best antifungal treatment and duration of antifungal treatment are still unclear, and the efficacy of using an antifungal agent-loaded cement spacer is still controversial. Until more evidence is available, focusing on prevention and identifying patients at risk of CPJI seems more than reasonable.

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

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.07.024 ◽

2018 ◽

Vol 33 (11) ◽

pp. 3555-3560 ◽

Cited By ~ 6

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

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The role of the primary care physician in early diagnosis of periprosthetic joint infection

Pediatria i Medycyna Rodzinna ◽

10.15557/pimr.2017.0049 ◽

2017 ◽

Vol 13 (4) ◽

pp. 460-469

Author(s):

Jerzy Białecki ◽

◽

Marcin Para ◽

Paweł Bartosz ◽

Wojciech Marczyński ◽

...

Keyword(s):

Primary Care ◽

Early Diagnosis ◽

Primary Care Physician ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Care Physician

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One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

Frontiers in Medicine ◽

10.3389/fmed.2020.540929 ◽

2020 ◽

Vol 7 ◽

Author(s):

Simon Marmor ◽

Younes Kerroumi ◽

Vanina Meyssonnier ◽

Luc Lhotellier ◽

Antoine Mouton ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Effective Strategy ◽

One Stage ◽

Exchange Arthroplasty

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Salmonella Sp. as the Cause of Periprosthetic Joint Infection of the Hip: Report of a Rare Case and Literature Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00049 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0004

Author(s):

Asep Santoso ◽

Iwan Budiwan Anwar ◽

Tangkas Sibarani ◽

Bintang Soetjahjo ◽

Ismail Mariyanto

Keyword(s):

Total Hip Arthroplasty ◽

Literature Review ◽

Antibiotic Treatment ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Periprosthetic Joint Infection ◽

Rare Case ◽

Joint Infection ◽

Immunosuppressed Patient ◽

Cement Spacer

Periprosthetic joint infection of the hip due to Salmonella sp. is rare. It is sometimes difficult to treat and needed a prolonged antibiotic treatment. We reported a case of periprosthetic joint infection of the hip in a 67 years old female who received prior left total hip arthroplasty. Two-stage revision surgery with antibiotic-loaded cement spacer has been performed to the patient and successfully control the infection. Review of the literatures also has been done. Salmonella Sp. has to be considered as one of differential etiology in the case of infected arthroplasty especially in an immunosuppressed patient. It showed still there has been no consensus in the treatment of choice for this particular case.

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