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The fate of fungal periprosthetic joint infection after total knee arthroplasty

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Abstract

Purpose

To demonstrate the clinical outcomes of patients with fungal periprosthetic joint infections (PJIs) after two-stage exchange arthroplasty combined with antifungal therapy.

Methods

We retrospectively reviewed the outcomes of 41 patients with fungal PJIs after primary total knee arthroplasty (TKA) in a single centre from January 1999 to October 2017. During the first stage of resection arthroplasty, antifungal-impregnated cement spacers (AICSs) were implanted in all patients. After systemic antifungal treatment during the interval between the two surgeries, delayed reimplantation as part of a two-stage exchange protocol was performed when patients were clinically stable. We defined treatment success as a well-functioning arthroplasty without any signs of PJI after a minimum follow-up of two years without antimicrobial suppression. Successful treatment was confirmed by repeat negative cultures as well as a return of inflammatory markers to normal levels.

Results

The treatment success rate was 63.4% at the final follow-up. Thirty-six of 41 patients (87.8%) met the criteria for second-stage revision after confirmation of complete infection control. The mean prosthesis-free interval was 6.6 months (range, 2.0–30.0 months). During follow-up after two-stage exchange arthroplasty, ten patients (27.7% of 36 patients) unfortunately experienced recurrence or relapse of infection after an average of 31.3 months (range, 2.7–135.6 months). The rate of survivorship free from reinfection was 94.4% at six months, 84.8% at one year, and 73.6% at two years. Cox proportional hazard regression analysis demonstrated that the prosthesis-free interval (HR = 1.016, p = 0.037) and mean length of antifungal treatment (HR = 0.226, p = 0.046) were potential risk factors for failure.

Conclusion

Fungal PJIs led to devastating clinical outcomes despite even two-stage revision arthroplasty with the use of AICSs and antifungal medications.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Code availability

Available from author JKS (email, seonbell@chonnam.ac.kr).

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Acknowledgements

The authors extend their sincere thanks to Joon Kyoo Kang, MD, and Jae Hyeok Cheon, MD, for assistance with the data analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro, 58128, Hwasun, Republic of Korea

    Hong Yeol Yang, Hyun Ho Shin, Ji Won Kim & Jong Keun Seon

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  2. Hyun Ho Shin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by H. Y. Y., H. H. S., and J. W. K. Review, editing, and supervision by J. K. S.

Corresponding author

Correspondence to Jong Keun Seon.

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Ethics approval

Institutional Review Board (IRB) of Chonnam National University Hwasun Hospital approved this study (CNUHH-2022-210).

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Not applicable.

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The authors declare no competing interests.

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Yang, H.Y., Shin, H.H., Kim, J.W. et al. The fate of fungal periprosthetic joint infection after total knee arthroplasty. International Orthopaedics (SICOT) 47, 2727–2735 (2023). https://doi.org/10.1007/s00264-023-05895-7

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