scholarly journals Candida Periprosthetic Joint Infection: Is It Curable?

Antibiotics ◽  
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.

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

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.

scholarly journals Copper-Coated Spacer for Total Femoral Replacement in Recurrent Periprosthetic Joint Infection: A Case Report

2021 ◽  
Vol 27 (1) ◽  
pp. 175-182
Author(s):  
A. Belokobylov ◽  
N. D. Batpenov ◽  
S. S. Balgazarov ◽  
V. D. Serikbayev ◽  
A. A. Krikliviy ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Sinus Tract ◽  
Knee Joints ◽  
Cement Spacer ◽  
Total Hip ◽  
The Right ◽  
Postoperative Scar

Background. There are few cases of entire femur modular replacement with hip and knee joints in patients with periprosthetic joint infection (PJI) in literature. They report encouraging results in patients of elderly and senile age. We present case of a copper-coated femoral spacer implantation to 50-year-old patient with multiple PJI episodes and osteomyelitis of the entire femur.Clinical presentation. A 40-year-old male patient after resection of the proximal part of the right femur for fibrotic osteodysplasia underwent total hip arthroplasty with replacement of 15 cm of the femur. In December 2010 (20 months after implantation), instability of the femoral component developed, revision arthroplasty was performed with stem recementation. After 4 months, sinus tract formed in the area of the postoperative scar. After another 4 months, the head of the prosthesis was dislocated. In September 2011, the endoprosthesis components were removed and a unipolar cement spacer was implanted. The limb immobilized in a hip spica cast. Methicillin-sensitive S. epidermidis (MSSE) was detected in the preoperative joint aspiration puncture and periprosthetic tissues. After 3 months (December 2011), patient underwent revision total hip arthroplasty (25 cm defect was replaced). 5 years of PJI remission followed. In November 2016 after PJI recurrence the endoprosthesis was removed, and an articulating spacer was implanted. P. aeruginosa was detected in periprosthetic tissues. For the past 2.5 years there were periodically sinus tracts formations. In August of 2019 spacer’s migration resulted in an intercondylar fracture of the right femur. In September 2019, spacer was removed, and MSSE was detected in the surrounding tissues. An articulating cement spacer based on an oncological modular total femur coppercoated endoprosthesis was implanted. At each control examination during the year copper concentration in blood serum was determined, it did not exceed 900–1200 mcg/l. No local or systemic side effects were detected. The patient started working 3 months after surgery. After 6 months poor functioning sinus tract formed in the postoperative scar area in the lower third of the thigh. 1.5 years after the operation, the functional condition is satisfactory.Conclusion. The use of the copper-coated spacer based on modular total femur endoprosthesis with hip and knee joints in a patient with multiple PJI allowed to improve the function of the limb and reduce the severity of the infectious process. No local or systemic toxic effects of copper were detected.

scholarly journals Is There a Role for Spacer Exchange in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection?

2020 ◽  
Vol 9 (9) ◽  
pp. 2901 ◽  
Author(s):  
Elie Kozaily ◽  
Emanuele Chisari ◽  
Javad Parvizi
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
The United States ◽  
Conclusive Evidence ◽  
Cement Spacer ◽  
Two Stage ◽  
Local Antibiotics ◽  
Additional Surgery ◽  
Surgeon Experience ◽  
Hip And Knee Arthroplasty

Periprosthetic joint infection (PJI) continues to be one of the most serious complications after hip and knee arthroplasty. The choice of surgical treatment depends on a multitude of factors like chronicity of infection, host factors, and institutional or surgeon experience. Two-stage exchange remains one of the most commonly used technique for chronic PJI in the United States of America. The intended two-stage revision may involve an additional interim procedure where the initial antibiotic cement spacer is removed and a new spacer is inserted. Mostly, the rationale behind spacer exchange is an additional load of local antibiotics before proceeding to reimplantation. There is no conclusive evidence whether a spacer exchange confers additional benefits, yet it delays reimplantation and exposes already fragile patients to the risks and morbidity of an additional surgery.

scholarly journals Creation of a Custom-Length, Humeral Antibiotic Cement Spacer for Use in Treatment of Shoulder Periprosthetic Joint Infection

2021 ◽  
Vol 10 (2) ◽  
pp. e481-e486
Author(s):  
Emma L. Klosterman ◽  
Eric J. Cotter ◽  
Matthew W. Squire ◽  
Brian F. Grogan
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Cement Spacer ◽  
Antibiotic Cement

scholarly journals Reliability of intra-operative frozen section study in revision of infected hip arthroplasty

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Karan Doshi ◽  
Deepesh Daultani ◽  
M. Ajith Kumar ◽  
Shantharam Shetty ◽  
Shailesh Pai
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Frozen Section ◽  
Joint Infection ◽  
Cement Spacer ◽  
High Power Field ◽  
Section Study ◽  
Thorough Debridement ◽  
Revision Prosthesis ◽  
Hip Arthroplasties

Abstract Introduction Frozen sections are extensively used to help in the diagnosis of periprosthetic joint infection during revision hip arthroplasty, though there are insufficient data in relation to its usefulness. Methods Twenty-one patients with infected hip arthroplasties were operated in the form of one or two-staged revision hip arthroplasties. A frozen section was obtained intra-operatively and > 5 PMN’s/ HPF was considered as a positive indicator of infection. If the frozen section was reported negative (≤5 PMN’s/HPF), the revision prosthesis was implanted after a thorough debridement and a wash. If the frozen section was reported as positive, post the debridement; a non-articulating antibiotic-loaded cement spacer was implanted for 8 weeks, supplemented with 3 weeks of intravenous antibiotics and 3 weeks of oral antibiotics. This was followed by an antibiotic-free interval of 2 weeks. The patient was taken up for a revision surgery once the frozen section study was negative (≤5 PMN’s/HPF). The patients were followed up for a minimum of 1 year to a maximum of 2 years after the revision for any evidence of infection (assessed clinically, serologically, and radiologically). Results Frozen section analysis of PMNs per high power field had a 100% specificity in our patients in detecting periprosthetic joint infection. Conclusion Frozen section study is a safe, rapid, cheap and reliable intra-operative modality to diagnose periprosthetic joint infection.

scholarly journals Salmonella sp. as the Cause of Periprosthetic Joint Infection of the Hip: Report of a Rare Case and Review of Past 10-year Literatures

2020 ◽  
Vol 8 (C) ◽  
pp. 117-120
Author(s):  
Asep Santoso ◽  
Pamudji Utomo ◽  
Iwan Budiwan Anwar ◽  
Tangkas Sibarani ◽  
Bintang Soetjahjo ◽  
...  
Keyword(s):  
Case Report ◽  
Total Hip Arthroplasty ◽  
Literature Review ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Rare Case ◽  
Joint Infection ◽  
Cement Spacer ◽  
Two Stage ◽  
Revision Procedure

BACKGROUND: Periprosthetic joint infection (PJI) due to Salmonella sp. is rare. It is sometimes difficult to treat and need prolonged antibiotic treatment. CASE REPORT: We reported a case of PJI of the hip in a 67-year-old female who received prior left total hip arthroplasty. Two-stage revision surgery with antibiotic-loaded cement spacer had been performed to the patient and successfully control the infection. CONCLUSION: Although literature review showed that there has been no consensus for the treatment of Salmonella PJI, a two-stage revision procedure has been more commonly performed to control the infection by previous authors and might be the safest way to control Salmonella PJI recently.

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

2018 ◽  
Vol 68 (12) ◽  
pp. 2087-2093 ◽  
Author(s):  
Marjan Wouthuyzen-Bakker ◽  
Michael M Kheir ◽  
Ignacio Moya ◽  
Alexander J Rondon ◽  
Matthew Kheir ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Cement Spacer ◽  
Exchange Arthroplasty

scholarly journals The use of augmented antibiotic-loaded cement spacer in periprosthetic joint infection patients with acetabular bone defect

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jun Fu ◽  
Yi Xiang ◽  
Ming Ni ◽  
Jiying Chen ◽  
Xiang Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bone Defect ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Cement Spacer ◽  
Two Stage ◽  
Acetabular Bone ◽  
Wall Defect ◽  
Second Stage ◽  
Acetabular Bone Defect

Abstract Background Spacer complications may affect final clinical outcome of the two-stage approach in periprosthetic joint infection (PJI) patients. This study aimed to investigate clinical outcomes and complications of augmented antibiotic-loaded cement spacer in PJI patients with acetabular bone defect. Methods Data on PJI patients with acetabular bone defect receiving two-stage revision from January 2009 to December 2016, in our hospital were retrospectively reviewed. Screw-cement-shell was used to improve the stability of the hip with acetabular wall defect. Handmade acetabular spacer could prevent femoral spacer entering into pelvis in patients with acetabular internal wall defect. A total of 26 patients (11 males and 15 females) were included in the current study. Their mean age was 46.7 ± 15.4 years old. Clinical outcomes and complications were measured. Results Twenty-one of total 26 hips (21/26, 80.8%) showed positive cultures and 15/26 (57.7%) samples were cultured with staphylococcus. Of enrolled patients, 5/26 (19.2%) developed mixed infection. There was one patient (3.8%) with spacer dislocation and two (7.7%) with spacer fracture. One patient developed acute PJI 5 years after the second-stage revision, so overall success rate among these patients was 96.2%. Differences in Paprosky classifications before the first and second stage did not reach significant level (p > 0.05). Hip Harris score was raised from 40.9 ± 14.0 to 81.2 ± 11.2 (p < 0.05). Conclusions Augmented antibiotic-loaded cement spacer could achieve satisfactory clinical outcomes in PJI patients with acetabular bone defect. It provided joint mobility, increased additional joint stability, and decreased iatrogenic bone defect caused by acetabular wear.

scholarly journals Knee arthrodesis as a salvage method for septic TKA failure

2019 ◽  
Vol 2 (1) ◽  
pp. 3-8
Author(s):  
Traian Ciobanu ◽  
Ioan Mihau Japie ◽  
Octavian Nutiu ◽  
Alexandru Papuc ◽  
Dragos Radulescu ◽  
...  
Keyword(s):  
External Fixation ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Surgical Techniques ◽  
Revision Arthroplasty ◽  
Ilizarov Method ◽  
Cement Spacer ◽  
Knee Arthrodesis ◽  
Knee Amputation ◽  
Prosthetic Implants

AbstractPeriprosthetic joint infection is the most common reason for a failed TKA, with a septic TKA reported rate of 1 to 4% of primary TKA patients. Septic TKA has a various number of treatment options which include chronic-suppressive antibiotics, irrigation and debridement, single or staged revision arthroplasty. The goal is to eradicate the periprosthetic joint infection and reimplant a sterile and fully functional total knee prosthesis. In case the infection becomes uncontrollable, there is only one option to eradicate the infection: knee arthrodesis or above-knee amputation.We report the case of a 63-year-old patient who in 2009 underwent TKA, the 1 year follow-up showed periprosthetic infection. At first stage, the prosthetic implants were removed and a solid cement spacer was shaped to occupy the remaining space. In 2011, after achieving complete clinical and biological remission of the infection, the cement spacer was removed and LCCK revision prosthesis was inserted.In 2013 reinfection occurred leading to removal of the prosthetic implants and reinsertion of an antibiotic impregnated cement spacer.Since the patient suffered significant bone loss and the local conditions were unfavorable, being prone to infection, there were 2 options to evaluate: knee arthrodesis or above knee amputation. We chose knee arthrodesis using Ilizarov external fixation technique.Many surgical techniques are available to achieve knee arthrodesis: internal fixation with plates or intramedullary nails and external fixation. The Ilizarov method is a very effective technique that could be taken into consideration when knee arthrodesis is required.

scholarly journals Capnocytophaga canimorsus Periprosthetic Joint Infection in an Immunocompetent Patient: A Case Report

2019 ◽  
Vol 10 ◽  
pp. 215145931882519 ◽  
Author(s):  
Blane C. Kelly ◽  
David S. Constantinescu ◽  
William Foster
Keyword(s):  
Case Report ◽  
Periprosthetic Joint Infection ◽  
Hip Prosthesis ◽  
Joint Infection ◽  
Immunocompetent Patient ◽  
Cement Spacer ◽  
Capnocytophaga Canimorsus ◽  
Musculoskeletal Infection ◽  
Hip Infection ◽  
Irrigation And Debridement

Introduction: A periprosthetic joint infection (PJI) is a potentially devastating complication following an arthroplasty procedure. There are many organisms that commonly cause this complication; in this case report, we will discuss a PJI caused by an unusual bacteria found in the mouths of domestic pets. Objective: To present a case report of a patient with a periprosthetic hip infection from Capnocytophaga canimorsus and review the literature. Methods: We present a case of C canimorsus PJI in an immunocompetent woman who had undergone a total hip arthroplasty. The patient was doing well postoperatively for many years until she was bitten on the foot by a domestic canine. Patient diagnosed using Musculoskeletal Infection Society criteria, then treated with explant of the hip prosthesis, irrigation and debridement, placement of an antibiotic cement spacer, and a 6-week course of intravenous antibiotics. Results: Unfortunately, while awaiting replant, this patient had a massive myocardial infarction and died. Discussion: Current literature suggests treating canine bites with amoxicillinas well as a discussion with patients pre-/postoperatively from a lower extremity arthroplasty specialist. Conclusion: Capnocytophaga canimorsus is a rare cause of infection, even more unusual in an immunocompetent patient. This study highlights the importance of considering C canimorsus as a cause of PJI, regardless of the immunologic status of the patient.

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