Federico Fusini1, Alessandro Aprato2, Alessandro Massè2, Alessandro Bistolfi2, Massimo Girardo3, Stefano Artiaco2. 1. Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, via Zuretti 29, Turin, Italy. fusinif@hotmail.com. 2. Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, via Zuretti 29, Turin, Italy. 3. Department of Orthopaedic and Traumatology, Spine Surgery Unit, Orthopaedic and Trauma Centre, via Zuretti 29, Turin, Italy.
Abstract
PURPOSE: To produce a systematic analysis of types of treatment and outcomes of Candida hip periprosthetic joint infections and their correlation with specific pathogen species. METHODS: During June 2018, a literature search of candida periprosthetic hip infection in PubMed, Scopus and Embase databases was performed according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guideline. Reviewers used Oxford level of evidence (LoE) and methodological index for non-randomised studies (MINORS) score. Modal distribution of surgical, pharmacological treatment and outcome along with the correlation between types of treatment and outcomes was calculated through the chi-square test. RESULTS: Seventy-nine cases were collected through 35 articles, identifying 81 pathogens. Candida albicans was the most common pathogen. Analysis of LoE reveals 26 LoE 5 (74.29%) and nine LoE 4 (26.71%). From nine LoE 4, ten patients (20.41%) underwent one-stage revision, 22 patients (44.90%) two-stage revision, 11 patients (22.45%) resection arthroplasty and six patients (12.24%) debridement with prosthesis retention. Global success was obtained in 31 cases (63.27%). Modal distribution revealed a preference for two-stage revision (22/49) and fluconazole as medical therapy (36/49). A significant difference was found between one-stage revision and resection arthroplasty (p = 0.031) or debridement (p = 0.003) and between two-stage revision and debridement (p = 0.013). No differences were found between Candida spp. in terms of the outcomes (p = 0.736). Methodological index showed a poor MINOR score. CONCLUSIONS: Analysis of the literature suggests better clinical outcome with one- or two-stage revision than with resection arthroplasty or debridement, but the level of evidence is low.
PURPOSE: To produce a systematic analysis of types of treatment and outcomes of Candida hip periprosthetic joint infections and their correlation with specific pathogen species. METHODS: During June 2018, a literature search of candida periprosthetic hip infection in PubMed, Scopus and Embase databases was performed according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guideline. Reviewers used Oxford level of evidence (LoE) and methodological index for non-randomised studies (MINORS) score. Modal distribution of surgical, pharmacological treatment and outcome along with the correlation between types of treatment and outcomes was calculated through the chi-square test. RESULTS: Seventy-nine cases were collected through 35 articles, identifying 81 pathogens. Candida albicans was the most common pathogen. Analysis of LoE reveals 26 LoE 5 (74.29%) and nine LoE 4 (26.71%). From nine LoE 4, ten patients (20.41%) underwent one-stage revision, 22 patients (44.90%) two-stage revision, 11 patients (22.45%) resection arthroplasty and six patients (12.24%) debridement with prosthesis retention. Global success was obtained in 31 cases (63.27%). Modal distribution revealed a preference for two-stage revision (22/49) and fluconazole as medical therapy (36/49). A significant difference was found between one-stage revision and resection arthroplasty (p = 0.031) or debridement (p = 0.003) and between two-stage revision and debridement (p = 0.013). No differences were found between Candida spp. in terms of the outcomes (p = 0.736). Methodological index showed a poor MINOR score. CONCLUSIONS: Analysis of the literature suggests better clinical outcome with one- or two-stage revision than with resection arthroplasty or debridement, but the level of evidence is low.
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