Successful 1-stage exchange total knee arthroplasty for fungal infection

Selmon, G; Slater, Rachael; Shepperd, J. A. N.; Wright, E. Pamela

doi:10.1016/s0883-5403(98)90086-9

Cited by 73 publications

(54 citation statements)

References 3 publications

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“…Candida albicans was the causative organism in twentyone of forty-six cases 11,13,14,19,20,[23][24][25]27,28,31,34 . Candida parapsilosis was the second leading cause of fungal periprosthetic joint infection and was isolated in eleven cases 10,12,15,18,26,30,[35][36][37]39,40 , Candida glabrata was isolated from five cases 7,16,17,29,32,33 , and Candida tropicalis from five cases 13,17,21,38 . Rhodotorula minuta was reported as the cause of a periprosthetic infection in one case report 41 .…”

Section: P Eriprosthetic Infection Caused By Fungal Pathogens Is Rarementioning

confidence: 99%

“…In other studies 24,30 , the diagnosis of candidal prosthetic infection has been confirmed with direct histologic evidence of fungi in retrieved osseous specimens. Several investigators 10,32,33,36 have stressed the importance of repeating fluid cultures and obtaining multiple positive tissue cultures before a diagnosis of fungal periprosthetic joint infection is made.…”

Section: P Eriprosthetic Infection Caused By Fungal Pathogens Is Rarementioning

confidence: 99%

See 1 more Smart Citation

Microbiological, Clinical, and Surgical Features of Fungal Prosthetic Joint Infections: A Multi-Institutional Experience

Azzam

Parvızı

Jungkind

et al. 2009

Journal of Bone and Joint Surgery

183

264

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Section: P Eriprosthetic Infection Caused By Fungal Pathogens Is Rarementioning

confidence: 99%

Section: P Eriprosthetic Infection Caused By Fungal Pathogens Is Rarementioning

confidence: 99%

Microbiological, Clinical, and Surgical Features of Fungal Prosthetic Joint Infections: A Multi-Institutional Experience

Azzam

Parvızı

Jungkind

et al. 2009

Journal of Bone and Joint Surgery

183

264

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“…Clinical procedures for the treatment of periprosthetic infection, include irrigation and debridement with component retention [3], as well as one-and two-stage exchange arthroplasty [4] and [5]. Two-stage exchange arthroplasty involves the implantation of an interim antibiotic-loaded component after removal of the original components.…”

mentioning

confidence: 99%

Adding functionality with additive manufacturing: Fabrication of titanium-based antibiotic eluting implants

Cox

Jamshidi

Eisenstein

et al. 2016

Materials Science and Engineering: C

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Additive manufacturing technologies have been utilised in healthcare to create patient-specific implants. This study demonstrates the potential to add new implant functionality by further exploiting the design flexibility of these technologies. Selective laser melting was used to manufacture titanium-based (Ti-6Al-4V) implants containing a reservoir. Pore channels, connecting the implant surface to the reservoir, were incorporated to facilitate antibiotic delivery. An injectable brushite, calciumphosphate cement, was formulated as a carrier vehicle for gentamicin. Incorporation of the antibiotic significantly (p=0.01) improved the compressive strength (5.8± 0.7 MPa) of the cement compared to non-antibiotic samples. The controlled release of gentamicin sulphate from the calcium phosphate cement injected into the implant reservoir was demonstrated in short term elution studies using ultraviolet visible spectroscopy. Orientation of the implant pore channels were shown, using micro-computed tomography, to impact design reproducibility and the back-pressure generated during cement injection which ultimately altered porosity. The amount of antibiotic released from all implant designs over a 6 hour period (b28% of the total amount) were found to exceed the minimum inhibitory concentrations of Staphylococcus aureus (16 μg/mL) and Staphylococcus epidermidis (1 μg/mL); two bacterial species commonly associated with periprosthetic infections. Antibacterial efficacy was confirmed against both bacterial cultures using an agar diffusion assay. Interestingly, pore channel orientation was shown to influence the directionality of inhibition zones. Promisingly, this work demonstrates the potential to additively manufacture a titanium-based antibiotic eluting implant, which is an attractive alternative to current treatment strategies of periprosthetic infections.

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“…[2][3][4][5][6][7][8][9][10][11][12] These are generally indolent, associated with impaired host immunity, and may be indistinguishable from common bacterial infections. Their diagnosis and treatment are therefore often delayed, which may prejudice the outcome.…”

mentioning

confidence: 99%

“…11 There is evidence that oral fluconazole penetrates tissues well and has excellent bioavailability. 27 However, the required duration of treatment is unclear.…”

mentioning

confidence: 99%

Fungal peri-prosthetic joint infection after primary total knee replacement

Hwang

Yoon

Nam

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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We retrospectively reviewed 30 two-stage revision procedures in 28 patients performed for fungal peri-prosthetic joint infection (PJI) after a primary total knee replacement. Patients were followed for at least two years or until the infection recurred. The mean follow-up for patients who remained free of infection was 4.3 years (2.3 to 6.1). Overall, 17 patients were assessed as American Society of Anesthesiologists grade 3 or 4. The surgical protocol included removal of the infected implant, vigorous debridement and insertion of an articulating cement spacer. This was followed by at least six weeks of antimicrobial treatment and delayed reimplantation in all patients. The mean interval between removal of the prosthesis and reimplantation was 9.5 weeks (6 to 24). After reimplantation, patients took antifungal agents orally for a maximum of six months. Two knees became reinfected at one and two months post-operatively, respectively: one of these subsequently required arthrodesis because of uncontrolled infection.Fungal PJIs can be treated successfully by removal of all infected material, appropriate antimicrobial treatment and delayed reimplantation.Peri-prosthetic joint infection (PJI) is one of the most serious complications of total knee replacement (TKR).

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Successful 1-stage exchange total knee arthroplasty for fungal infection

Cited by 73 publications

References 3 publications

Microbiological, Clinical, and Surgical Features of Fungal Prosthetic Joint Infections: A Multi-Institutional Experience

Microbiological, Clinical, and Surgical Features of Fungal Prosthetic Joint Infections: A Multi-Institutional Experience

Adding functionality with additive manufacturing: Fabrication of titanium-based antibiotic eluting implants

Fungal peri-prosthetic joint infection after primary total knee replacement

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