Feng-Chih Kuo1, Karan Goswami2, Noam Shohat3, Kier Blevins2, Alexander J Rondon2, Javad Parvizi2. 1. Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; The Rothman Institute at Thomas Jefferson University, Philadelphia, PA; College of Medicine, Chang Gung University, Kaohsiung, Taiwan. 2. The Rothman Institute at Thomas Jefferson University, Philadelphia, PA. 3. The Rothman Institute at Thomas Jefferson University, Philadelphia, PA; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Abstract
BACKGROUND: This study investigated the prevalence of medical comorbidities, risk factors, and treatment outcomes in patients with fungal periprosthetic joint infection (PJI). METHODS: All patients with fungal PJI treated from 1999 to 2014 were retrospectively identified at a single institution. Demographic data, comorbidity, and surgical variables were obtained from medical records. Patients were followed up for at least 2 years. PJI was diagnosed using the Musculoskeletal Infection Society criteria. Treatment success was defined using the Delphi consensus criteria. Kaplan-Meier survivorship curves with 95% confidence interval were used for analysis. RESULTS: Overall, fungal PJIs accounted for 2.4% of the PJI treated at our institution. Twenty-seven patients (93.1%) had 2 or more underlying systemic illnesses. Age and revision surgery were significant risk factors for development of fungal PJI after adjusting for confounding variables. Overall treatment success was 55.2% at 1 year and 40.5% at 5 years. When stratified by initial surgical management, treatment success was 57.1% at 1 year and 28.6% at 5 years following irrigation and debridement; 33.3% at 1 year and 5 years following 1-stage revision; and 57.9% at 1 year and 46.3% at 5 years for 2-stage exchange arthroplasty. CONCLUSION: Patients with fungal PJI have a high prevalence of systemic illness and poor outcome after surgical management. Irrigation and debridement and single-stage revision demonstrate poor longterm outcomes and may have no place as treatment choices for fungal PJI. Moving forward, our efforts should concentrate on optimizing the systemic status of these patients prior to 2-stage exchange arthroplasty.
BACKGROUND: This study investigated the prevalence of medical comorbidities, risk factors, and treatment outcomes in patients with fungal periprosthetic joint infection (PJI). METHODS: All patients with fungal PJI treated from 1999 to 2014 were retrospectively identified at a single institution. Demographic data, comorbidity, and surgical variables were obtained from medical records. Patients were followed up for at least 2 years. PJI was diagnosed using the Musculoskeletal Infection Society criteria. Treatment success was defined using the Delphi consensus criteria. Kaplan-Meier survivorship curves with 95% confidence interval were used for analysis. RESULTS: Overall, fungal PJIs accounted for 2.4% of the PJI treated at our institution. Twenty-seven patients (93.1%) had 2 or more underlying systemic illnesses. Age and revision surgery were significant risk factors for development of fungal PJI after adjusting for confounding variables. Overall treatment success was 55.2% at 1 year and 40.5% at 5 years. When stratified by initial surgical management, treatment success was 57.1% at 1 year and 28.6% at 5 years following irrigation and debridement; 33.3% at 1 year and 5 years following 1-stage revision; and 57.9% at 1 year and 46.3% at 5 years for 2-stage exchange arthroplasty. CONCLUSION:Patients with fungal PJI have a high prevalence of systemic illness and poor outcome after surgical management. Irrigation and debridement and single-stage revision demonstrate poor longterm outcomes and may have no place as treatment choices for fungal PJI. Moving forward, our efforts should concentrate on optimizing the systemic status of these patients prior to 2-stage exchange arthroplasty.
Authors: Daniel Karczewski; Yi Ren; Octavian Andronic; Doruk Akgün; Carsten Perka; Michael Müller; Arne Kienzle Journal: Int Orthop Date: 2021-11-16 Impact factor: 3.075
Authors: Dariusz Grzelecki; Aleksandra Grajek; Piotr Dudek; Łukasz Olewnik; Nicol Zielinska; Petr Fulin; Maria Czubak-Wrzosek; Marcin Tyrakowski; Dariusz Marczak; Jacek Kowalczewski Journal: J Fungi (Basel) Date: 2022-07-29