Efficacy evaluation of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection
10.3760/cma.j.issn.0529-5815.2019.05.006
- VernacularTitle: 一期翻修联合关节腔内注射抗真菌药物治疗慢性假体周围真菌感染的效果评价
- Author:
Chen ZOU
1
;
Boyong XU
;
Wentao GUO
;
Wenbo MU
;
Baochao JI
;
Li CAO
Author Information
1. Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Publication Type:Journal Article
- Keywords:
Arthroplasty;
Treatment outcome;
Periprosthetic joint infection;
Single-stage revision;
Fungal infection
- From:
Chinese Journal of Surgery
2019;57(5):348-352
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection.
Methods:A retrospective analysis of 11 patients(4 hips, 7 knees) admitted with chronic periprosthetic fungal infection at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2004 to April 2016.There were males and females with an age of 67 years (range:47-77 years). Each patient underwent single-stage revision including aggressive soft-tissue debridement. Liquid samples and tissue samples were immediately sent to the microbiology laboratory for drug sensitivity testing and histological analysis. Removed the infected components and cement thoroughly, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungussensitive antibiotics. The patients with infected hips received an uncemented prosthesis and 0.5 g of gentamicin loaded commercial cement was received by the patients with infected knee.After that, a new prosthesis was implanted.Long-term combination therapy of antibacterial agents and antifungal agents were given after operation. Recurrence of infection and clinical outcomes were evaluated. The follow-up period was 5 years (range: 2-12 years).
Results:One patient died of acute heart failure on the eighth postoperative day.Three infection cases were recurred.Eight cases had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score assessed preoperatively and at latest follow-up was increased from 39.25±5.12 to 79.50±4.79, the difference was statistically significant (t=-11.356, P=0.001).The Hospital for Special Surgery knee score was improved from preoperative 46.25±5.61 to final follow-up 80.50±5.06, and the difference was statistically significant (t=-9.930, P=0.002).
Conclusion:Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes.
