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Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Hong Yeol Yang, MD, PhD
KOREA, REPUBLIC OF

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Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF

Chonnam National University Hospital, Gwangju, Jeolanamdo, KOREA, REPUBLIC OF

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Anatomic Location

Knee Tibio - Fibular

Diagnosis / Condition

Infection Osteoarthritis

Treatment / Technique

Total Joint Replacement Arthroplasty

Sports Medicine

Outcome Studies

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

Introduction

Fungal periprosthetic joint infections (PJIs) are rare; however, they are of great clinical relevance because their diagnosis and treatment are highly challenging. The purpose of this study was to investigate the clinical outcomes of patients with fungal PJIs treated with two-stage exchange knee arthroplasty combined with prolonged antifungal therapy.

Methods

& Materials:
We reviewed our institutional joint arthroplasty database and identified 41 patients who were diagnosed with fungal PJIs and treated with two-stage exchange arthroplasty after primary total knee arthroplasty (TKA) between January 2001 and December 2020 at our center. These patients were compared with patients who had non-fungal PJIs during the same period. After propensity score matching based on age, sex, body mass index, American Society of Anesthesiologists (ASA) grade, and Charlson Comorbidity Index (CCI), 40 patients in each group were successfully matched. The surgical and antimicrobial treatment, patient demographic and clinical data, re-infections, survival rates, and relevant risk factors that affected joint survivorship were analyzed. We defined treatment success as a well-functioning arthroplasty without any signs of a PJI and without antimicrobial suppression after a minimum follow-up from the time of reimplantation of two years.

Results

The fungal PJI group demonstrated a significantly worse treatment success rate at the final follow-up than the non-fungal PJI group (65.0% versus 85.0%; p < 0.001). The mean prosthesis-free interval was longer in the fungal PJI group than in the non-fungal PJI group (6.7 weeks versus 4.1 weeks; p = 0.020). The rate of survivorship free from reinfection was worse in the fungal PJI group (83.4% at 1 year and 76.4% at 2 years) than in the non-fungal PJI group (97.4% at 1 year and 90.3% at 2 years), but the differences were not significant (p = 0.270; log-rank test). Cox proportional hazard regression analysis identified the duration of the prosthesis-free interval as a potential risk factor for failure (HR = 1.128, p = 0.043).

Conclusions

Fungal PJIs had a lower treatment success rate than non-fungal PJIs despite two-stage revision arthroplasty and appropriate antifungal treatment. Our findings highlight the need to develop novel treatments for fungal PJIs that more completely eradiate these infections.

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Tibia Placement Difference Between The Supine And Prone Position After Total Knee Arthroplasty: The Comparison Of The BCS and PS-TKA ePoster Presentation Takanori Iriuchishima, MD, PhD, JAPAN Keinosuke Ryu, MD, PhD, JAPAN Eiji Cho, MD, JAPAN
Accuracy of the Component Alignment and Sizing in Total Knee Arthroplasty: Preoperative Templating and Postoperative Evaluation Using CT-Based 3D Pre-Operative Planning Software ePoster Presentation Takayuki Koya, MD, PhD, UNITED STATES Atsushi Sato, MD, PhD, JAPAN Jun Oike, MD,PhD, JAPAN Masataka Ota, MD, JAPAN Kanako Izukashi, MD, JAPAN Takayuki Okumo, MD, PhD, JAPAN Saki Yagura, MD, JAPAN Naoki Okuma, MD, JAPAN Fumiyoshi Kawashima, MD, JAPAN Hiroshi Takagi, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN
Total Knee Arthroplasty Without Patellar Component Replacement. Does it Increase the Risk of Revision? Local Experience Analysis ePoster Presentation Zoy Anastasiadis, MD, CHILE Diego Edwards, MD, CHILE Sergio Arellano, MD, CHILE Andrés Schmidt-Hebbel, MD, CHILE Eduardo Gardella, MD, CHILE Nicolás González-Kusjanovic, MD, CHILE Alex Vaisman, MD, Prof., CHILE
Large Reduction In Postoperative Posterior Tibial Slope Risks Anterior Collapse Of The Tibial Component In Fixed-Bearing Unicompartmental Knee Arthroplasty ePoster Presentation Kazuhisa Hatayama, MD, PhD, JAPAN Masanori Terauchi, MD, JAPAN Shingo Kurihara, MD, JAPAN Satoshi Nonaka, MD, JAPAN Hibiki Kakiage, MD, JAPAN
High Cure Rate In Hematogenous TKA PJI At A Long-Term Follow-Up By Means Of Dair Procedure ePoster Presentation Daniel Pérez-Prieto, MD, SPAIN Albert Fontanellas, MD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Juan Francisco Sanchez-Soler, MD, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN Pedro Hinarejos-Gomez, MD, PhD, SPAIN
Modular Knee Arthrodesis as Definitive Treatment for Periprosthetic Infection, Bone Loss, and Failure of the Extensor Mechanism after Total Knee Arthroplasty ePoster Presentation Gloria Shoshana Coden, MD, UNITED STATES Maksym Bartashevskyy, BA, UNITED STATES Zachary Berliner, MD, UNITED STATES Ruijia Niu, MPH, UNITED STATES James V. Bono, MD, UNITED STATES Ayesha Abdeen, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES
Effect of Restricted Kinematic Alignment Total Knee Arthroplasty on Coronal Plane Alignment Of The Ankle Joint ePoster Presentation Bartosz Michał Maciąg, MD, POLAND Marcin Łapiński, MD, POLAND Tomasz Mrozek, MD, POLAND Adrian Góralczyk, MD, POLAND Maciej Swiercz, MD, POLAND Grzegorz Maciąg, POLAND Krystian Żarnovsky, POLAND Olga Adamska, POLAND Artur Stolarczyk, MD, PhD, POLAND
Does 1000 Mg Ferric Carboxylate Maltose Have an Additional Benefit on the Haemoglobin Recovery Post Total Knee Arthroplasty? - A Comparison with 500 Mg of Ferric Carboxymaltose ePoster Presentation Adit Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, CANADA Ashwini Khokhar, MS, INDIA Akshay Nayak, M.B.B.S, M.S , INDIA Naveen Chandar, MBBS, INDIA Abhinav Mishra, MS, DNB, INDIA Rajesh Maniar, INDIA
Clinical Comparison and Survival Rate Between Unicompartmental Knee Arthroplasty and High Tibial Osteotomy With An External Fixator For Varus Knee In Patients Younger Than 60 Years at Mid-Term Follow-Up ePoster Presentation Amit Kumar Yadav, M.S (Orth),DNB(Orth),MNAMS, INDIA Riccardo D'Ambrosi, MD, ITALY Mangal Parihar, MS Ortho, INDIA
Relationship Between The Femoral And Tibial Component Positions And Postoperative Knee Range Of Motion After Posterior-Stabilized Total Knee Arthroplasty ePoster Presentation Mitsuru Hanada, MD, PhD, JAPAN Yukihiro Matsuyama, MD, PhD, Prof., JAPAN
Phenotypic Differences In Coronal Alignment In Robot-Assisted Total Knee Arthroplasty Do Not Affect Patient-Reported Outcome Measurements In A Three-Dimensional Computed Tomography Analysis: A Single-Center Cohort Study ePoster Presentation Takao Kaneko, MD, PhD,, JAPAN Ayakane Yamamoto, MD, JAPAN Kazutaka Takada, MD, JAPAN Shu Yoshizawa, MD, JAPAN Hiroyasu Ikegami, MD, PhD, Prof., JAPAN
Knee Arthroscopy Prior to UKA Does Not Cause Infection ePoster Presentation Kevin D. Plancher, MD, MPH, UNITED STATES Karen Briggs, MPH, UNITED STATES Stephanie C. Petterson, MPT, PhD, UNITED STATES

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Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis

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Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Introduction

Methods

Results

Conclusions

More 2023 ISAKOS Congress Content