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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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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, JAPAN 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
A Prospective Randomised Study to Compare the Clinical and Radiological Outcomes of Functionally Aligned versus Mechanically Aligned Total Knee Arthroplasty with Robotic Arm Assistance ePoster Presentation Jai Thilak Kailathuvalapil, MS, MCh, FRCS, INDIA Amal Antony Paul, MBBS, INDIA
The Functional Outcome of Zimmer Biomet’s Nexgen Total Knee Arthroplasty as Compared with Healthy Older Adults ePoster Presentation Gwenllian F. Tawy, PhD, MRes, BSc(Hons), UNITED KINGDOM Michael J. McNicholas, BSc, MD, FRCS Tr & Orth, UNITED KINGDOM Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth), UNITED KINGDOM
Influence of Mini Approach Instrumentation on Component Alignment In Unicondylar Knee Replacement ePoster Presentation Vinod Kumar, MBBS, MS, DNB, MNAMS, INDIA Deepak Gupta, MBBS, MS, INDIA Ananya Sharma, MBBS, MS, DNB , INDIA
Compliance and Outcome of Osteoporosis Treatment After Total Knee Arthroplasty ePoster Presentation Yun Seong Choi, MD, KOREA, REPUBLIC OF Seung Hoon Lee, MD, KOREA, REPUBLIC OF Jung Ro Yoon, MD, KOREA, REPUBLIC OF Young Bin Shin, MD, KOREA, REPUBLIC OF Tae Hyuk Yoon, MD, KOREA, REPUBLIC OF
Combined Single-Shot Infiltration Between the Popliteal Artery and Capsule of the Knee and Adductor Canal Block with Bupivacaine, Dexmedetomidine, and Dexamethasone for Total Knee Arthroplasty: A Propensity-Matched Analysis ePoster Presentation David Freccero, MD, UNITED STATES Aneesh V Samineni, BA, UNITED STATES Seroos Salavati, MD, UNITED STATES
Patella in Total Knee Replacement: Patellar Resurfacing has Better Outcomes than Lateral Facetectomy at One Year Follow-Up ePoster Presentation Tomas Alfredo Esteves, MD, ARGENTINA Matias Novillo, MD, ARGENTINA Tomas Nicolino, MD, ARGENTINA Matias Costa-Paz, MD, PhD, ARGENTINA Lisandro Carbó, MD, ARGENTINA Julian Costantini, MD, ARGENTINA
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
Combined Fixed-Bearing Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction ePoster Presentation Claudio Legnani, MD, ITALY Enrico Borgo, MD, ITALY Vittorio Macchi, MD, ITALY Alberto Ventura, MD, ITALY
No Difference In Sports Participation And Patient-Reported Functional Outcomes Between Total Knee Arthroplasty And Unicompartmental Knee Arthroplasty At Minimum 2-Year Follow-Up In A Matched Control Study ePoster Presentation Amit Meena, MBBS, MS, DNB, INDIA Elisabeth Abermann, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Luca Farinelli, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Akshya Raj, MBBS,MS, INDIA Mohit Kumar Patralekh, MBBS, MS(Orthopaedics), DNB(Orthopaedics), MNAMS, INDIA Christian Fink, MD, Prof., AUSTRIA
Lateral Unicompartmental Knee Arthroplasty (UKA) Showed a Lower Risk of Failure Compared to Medial Unicompartmental Knee Arthroplasty in the Register of Prosthetic Orthopedic Implants (RIPO) ePoster Presentation Stefano Zaffagnini, MD, Prof., ITALY Domenico Alesi, MD, ITALY Barbara Bordini, Stat, ITALY Stefano Fratini, MD, ITALY Cristina Ancarani, Stat, ITALY Piero Agostinone, MD, ITALY Alberto Grassi, PhD, ITALY Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY

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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