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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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Anatomical distribution of radiological OA Influences the Outcome of TKA ePoster Presentation Johanna Elliott, MB, BS, B.Med Sci, Master Science, GERMANY
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, Prof., JAPAN Eiji Cho, MD, JAPAN
Total Knee Arthroplasty Outcomes Following Anterior Cruciate Ligament Reconstruction ePoster Presentation Brian Rao, BS, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Eric Milliron, BS, UNITED STATES Parker Cavendish, BS, UNITED STATES James C. Kirven, BS, UNITED STATES Spencer E. Talentino, MD, UNITED STATES Charles Qin, MD, UNITED STATES Ryan H. Barnes, MD, UNITED STATES Robert A. Duerr, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Robert A Magnussen, MD, MPH, UNITED STATES David C. Flanigan, MD, UNITED STATES
Golfers Have Greater Preoperative and Equal Postoperative Function When Undergoing Total Knee Arthroplasty Compared to Non-Golfers ePoster Presentation Patrick G Robinson, MBChB, MRCS, MS, MBA, UNITED KINGDOM Robert Kay, MBChB, UNITED KINGDOM Deborah Macdonald, BA(Hons), UNITED KINGDOM Andrew Murray, MBChB, FFSEM, UNITED KINGDOM Nick David Clement, MBBS, MD, PhD, FRCS(Orth), UNITED KINGDOM
Central Sensitization is Associated with Persistent Postoperative Pain and Inferior Patient-Reported Outcomes in Patients Undergoing Unicompartmental Knee Arthroplasty ePoster Presentation Yong In, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF
Patellofemoral Arthroplasty In Community Programs: Case Series of 425 Patients ePoster Presentation Alexander P. Sah, MD, UNITED STATES
The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review ePoster Presentation Kyle William Lawrence, BS, UNITED STATES John K Cordero, MD, UNITED STATES Ashley Brown, BS, UNITED STATES Xinning Li, MD, UNITED STATES Brett Hayden, MD, UNITED STATES Robert L Parisien, MD, UNITED STATES
Long-Term Results of Per-Operative Knee Arthroscopy in Confirming Suitability for Unicompartmental Arthroplasty ePoster Presentation James Gill, MB BChir, BSc, FRCS, UNITED KINGDOM McMeniman J Peter, AUSTRALIA Timothy John Mcmeniman, MBBS(Med)/MBBS, FRACS FA(Orth)A, AUSTRALIA Daniel Johnson Brimm, BSc, MD, AUSTRALIA Peter T. Myers, AM, MBBS, FRACS, FAOrthA, AUSTRALIA
Effect of Direct Adductor Canal Block Performed by a Surgeon in a Patient Who Underwent Simultaneous Bilateral TKA ePoster Presentation Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Yong In, MD, PhD, KOREA, REPUBLIC OF
Quality of Life Following Primary Total Knee Arthroplasty: Factors Predicting Satisfaction in Low-Income Population ePoster Presentation Mohamed Amine Gharbi , MD, TUNISIA Houssem Eddine Chahed, MD, TUNISIA Ahmed Zendeoui, MD, TUNISIA Moatassem Belleh Jelassi, MD, TUNISIA Anis Tebourbi, MD, TUNISIA Ramzi Bouzidi, PhD, TUNISIA Khelil Ezzaouia, PhD, TUNISIA Mouadh Nefiss, MD, TUNISIA
Use of Tibial Stem for Patients with Morbid Obesity in Total Knee Arthroplasty ePoster Presentation José Eduardo Flores Naranjo, MD, MEXICO Adrian Aziz Cortes De La Fuente, MD, MEXICO Octavio Martinez Montiel, MD, MEXICO Fernando Martinez Zuñiga, MD, MEXICO
Incidence and Prevention of Deep Vein Thrombosis Using Thromboprophylaxis in Total Knee Replacement: A Prospective Clinical Study ePoster Presentation Amit Lakhani, MS, DNB, MRCPS(Glassg), MNAS, INDIA

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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