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What Is the Success of Treatment of Hip and Knee Candidal Periprosthetic Joint Infection?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Fungal infection at an arthroplasty site is rare and poses a therapeutic challenge. To the best of our knowledge, no reports have been published thus far on the success rate of prosthesis reimplantation after fungal prosthetic joint infections.

Questions/purposes

We asked: (1) What is the success rate in terms of infection eradication using a two-stage exchange arthroplasty in patients with hip or knee fungal periprosthetic joint infections, particularly focusing on Candida infections? (2) What patient-, infection-, and treatment-related variables are associated with the success or failure of treatment?

Methods

From January 2000 to December 2010, 16 patients with hip or knee candidal periprosthetic joint infections were treated with two-stage exchange arthroplasty at our institute. Treatment success was defined as a well-functioning joint without relapse of candidal infection after prosthesis reimplantation, while treatment failure was defined as uncontrolled or relapse of candidal infection or mortality. Variables, including age, sex, comorbidities, microbiology, antimicrobial agents used, and operative methods, were analyzed. Minimum followup was 28 months (mean, 41 months; range, 28–90 months).

Results

At latest followup, the treatment failed to eradicate the infection in eight of the 16 patients, and there were four deaths related to fungemia. Four patients required permanent resection arthroplasty owing to uncontrolled or recurrent candidal infections. All eight patients (50% successful rate) who had their infections eradicated and successful prosthesis reimplantation had prolonged treatment with oral fluconazole before (mean, 8 months) and after (mean, 2.2 months) prosthesis reimplantation. The antifungal therapy correlated with successful treatment. Renal insufficiency, hypoalbuminemia, anemia, and chronic obstructive pulmonary disease were significantly more prevalent in the treatment-failure group than in the treatment-success group.

Conclusions

Half of the patients treated with two-stage exchange arthroplasty for fungal periprosthetic joint infections had recurrence or lack of control of the infection. A prolonged antifungal therapy appeared to be essential for successful treatment of candidal periprosthetic joint infections. The presence of renal insufficiency, hypoalbuminemia, anemia, or chronic obstructive pulmonary disease might be associated with a poor outcome.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Chee Jen Chang PhD (Chang Gung University, Taoyuan, Taiwan) for assistance with the statistical analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St, Kweishan, Linkou, 333, Taiwan

    Steve W. N. Ueng MD, Chih-chien Hu MD, Pang-Hsin Hsieh MD & Yuhan Chang MD, PhD

  2. School of Medicine, Chang Gung University, Taoyuan, Taiwan

    Steve W. N. Ueng MD, Chih-chien Hu MD, Pang-Hsin Hsieh MD & Yuhan Chang MD, PhD

  3. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Ching-Yu Lee MD

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  1. Steve W. N. Ueng MD
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Corresponding author

Correspondence to Yuhan Chang MD, PhD.

Additional information

This work was supported by the Chang Gung Memorial Hospital (Grant no. CMRPG 391583) and Taiwan National Science Council (Grant no. 101-2314-B-182A-003) (YC).

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Chang Gung Memorial Hospital, Linkou, Taiwan.

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Ueng, S.W.N., Lee, CY., Hu, Cc. et al. What Is the Success of Treatment of Hip and Knee Candidal Periprosthetic Joint Infection?. Clin Orthop Relat Res 471, 3002–3009 (2013). https://doi.org/10.1007/s11999-013-3007-6

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  • DOI: https://doi.org/10.1007/s11999-013-3007-6

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