J Korean Orthop Assoc.  2019 Feb;54(1):52-58. 10.4055/jkoa.2019.54.1.52.

Clinical Result of a Staged Reimplantation of Fungus Related Periprosthetic Joint Infection after Total Knee Arthroplasty

• Kim HJ
• Bae KC
• Min KK
• Choi HU

• KMID: 2438963
• DOI: http://doi.org/10.4055/jkoa.2019.54.1.52

Abstract

PURPOSE
Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). On the other hand, a standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. The clinical progress of staged reimplantation in patients who had fungus-related PJI after TKA was reviewed retrospectively.
MATERIALS AND METHODS
Ten patients who had a fungal related PJI after TKA between 2006 and 2017 using staged reimplantation surgery were reviewed. These patients were compared with 119 patients who had a PJI in the same period. The failure rate of infection control, intravenous antimicrobial using the period, and the clinical results were evaluated by comparing the range of motion and Korean knee score (KKS) between pre-staged reimplantation and the last follow-up.
RESULTS
In the fungal infection group, 7 out of 10 cases (70.0%) had failed in infection control using staged reimplantation and in the non-fungal group, 7 out of 119 cases (5.9%) had failed (p=0.04). In the non-fungal group, the mean duration of antibiotics was 6.2 weeks. In the fungus group, the mean duration of antibiotics was 15.3 weeks, which was 9.1 weeks longer (p < 0.001). The range of motion of the knee was increased in the two groups (p=0.265). At the last follow-up, the KKS was 71.01 points in the non-fungal group and 61.3 points in the fungal group (p=0.012). Erythrocyte sedimentation rate and C-reactive protein (CRP) decreased in the two groups, but the CRP was significantly different in the two groups (p=0.007).
CONCLUSION
The treatment of fungus-related PJIs using staged reimplantation showed uneven clinical progress and unsatisfactory clinical improvements compared to non-fungal PJI. Therefore, it is necessary to consider the use of an antifungal mixed cement spacer at resection arthroplasty and oral antifungal agent after reimplantation.

Keyword

knee; fungal infection; revision total knee arthroplasty; 2-stage

MeSH Terms

Anti-Bacterial Agents
Arthroplasty
Arthroplasty, Replacement, Knee*
Blood Sedimentation
C-Reactive Protein
Follow-Up Studies
Fungi*
Hand
Humans
Infection Control
Joints*
Knee
Range of Motion, Articular
Replantation*
Retrospective Studies
Anti-Bacterial Agents
C-Reactive Protein

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