Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty
Purpose Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication of hip or knee joint arthroplasty. The experience for outcomes of NTMPJI treatment is still limited. The objective of this study was to investigate the outcome of hip or knee nontuberculous mycobacteri...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-11-01
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| Series: | Journal of Orthopaedic Surgery |
| Online Access: | https://doi.org/10.1177/10225536221140610 |
| _version_ | 1797983931127037952 |
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| author | Shih-Hui Peng Sheng-Hsun Lee Chun-Chieh Chen Yu-Chih Lin Yuhan Chang Pang-Hsin Hsieh Hsin-Nung Shih Steve W N Ueng Chih-Hsiang Chang |
| author_facet | Shih-Hui Peng Sheng-Hsun Lee Chun-Chieh Chen Yu-Chih Lin Yuhan Chang Pang-Hsin Hsieh Hsin-Nung Shih Steve W N Ueng Chih-Hsiang Chang |
| author_sort | Shih-Hui Peng |
| collection | DOAJ |
| description | Purpose Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication of hip or knee joint arthroplasty. The experience for outcomes of NTMPJI treatment is still limited. The objective of this study was to investigate the outcome of hip or knee nontuberculous mycobacteria periprosthetic joint infection following treatment with two-stage exchange arthroplasty. Material and Methods From 1995 to 2020, 12 patients with NTMPJI were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidity, microbiological data, treatment outcome and antibiotic formula in bone cement. Results Mycobacterium abcessus ( n = 6) and Mycobacterium chelonae ( n = 2) constitute the majority of the cases. Five patients had early-onset PJIs and the other seven patients were late onset. The success rate of two-stage exchange arthroplasty was 66.7% (8 of 12). Three patients experienced infection relapse, and one patient had soft tissue compromise complication. Post-operative antibiotic therapy may not improve the success rate (4 of 6 cases, 66.7%). Based on in vitro study, the most commonly used effective antibiotic in bone cement spacer for nontuberculous mycobacteria was amikacin. Conclusions nontuberculous mycobacteria is a rare cause of PJIs and should be suspected especially in relatively immunocompromised patients. Resection arthroplasty with staged reimplantation is the preferred approach. Prolonged post-operative antibiotic therapy before reimplantation may not improve the success rate. Delayed revision surgery may not be needed and can be performed once C-reactive protein level is normal after a drug holiday. |
| first_indexed | 2024-04-11T06:54:56Z |
| format | Article |
| id | doaj.art-c1a75c770aeb4501b85dd6bb568f34b5 |
| institution | Directory Open Access Journal |
| issn | 2309-4990 |
| language | English |
| last_indexed | 2024-04-11T06:54:56Z |
| publishDate | 2022-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Orthopaedic Surgery |
| spelling | doaj.art-c1a75c770aeb4501b85dd6bb568f34b52022-12-22T04:39:04ZengSAGE PublishingJournal of Orthopaedic Surgery2309-49902022-11-013010.1177/10225536221140610Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplastyShih-Hui PengSheng-Hsun LeeChun-Chieh ChenYu-Chih LinYuhan ChangPang-Hsin HsiehHsin-Nung ShihSteve W N UengChih-Hsiang ChangPurpose Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication of hip or knee joint arthroplasty. The experience for outcomes of NTMPJI treatment is still limited. The objective of this study was to investigate the outcome of hip or knee nontuberculous mycobacteria periprosthetic joint infection following treatment with two-stage exchange arthroplasty. Material and Methods From 1995 to 2020, 12 patients with NTMPJI were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidity, microbiological data, treatment outcome and antibiotic formula in bone cement. Results Mycobacterium abcessus ( n = 6) and Mycobacterium chelonae ( n = 2) constitute the majority of the cases. Five patients had early-onset PJIs and the other seven patients were late onset. The success rate of two-stage exchange arthroplasty was 66.7% (8 of 12). Three patients experienced infection relapse, and one patient had soft tissue compromise complication. Post-operative antibiotic therapy may not improve the success rate (4 of 6 cases, 66.7%). Based on in vitro study, the most commonly used effective antibiotic in bone cement spacer for nontuberculous mycobacteria was amikacin. Conclusions nontuberculous mycobacteria is a rare cause of PJIs and should be suspected especially in relatively immunocompromised patients. Resection arthroplasty with staged reimplantation is the preferred approach. Prolonged post-operative antibiotic therapy before reimplantation may not improve the success rate. Delayed revision surgery may not be needed and can be performed once C-reactive protein level is normal after a drug holiday.https://doi.org/10.1177/10225536221140610 |
| spellingShingle | Shih-Hui Peng Sheng-Hsun Lee Chun-Chieh Chen Yu-Chih Lin Yuhan Chang Pang-Hsin Hsieh Hsin-Nung Shih Steve W N Ueng Chih-Hsiang Chang Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty Journal of Orthopaedic Surgery |
| title | Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty |
| title_full | Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty |
| title_fullStr | Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty |
| title_full_unstemmed | Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty |
| title_short | Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty |
| title_sort | nontuberculous mycobacteria peri prosthetic joint infection an outcome analysis for two stage revision arthroplasty |
| url | https://doi.org/10.1177/10225536221140610 |
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