Hypoalbuminemia Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee

Green, Cody C.; Valenzuela, Michael M.; Odum, Susan; Rowe, Taylor; Springer, Bryan D.; Fehring, Thomas K.; Otero, Jesse E.

doi:10.1016/j.arth.2023.01.012

Cited by 11 publications

(9 citation statements)

References 18 publications

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“…Hypoalbuminemia is known to be associated with poor PJI outcomes. [28–30] Furthermore, the development and prognosis of respiratory diseases, such as the postoperative interstitial pneumonia in this case, have been found to be closely related to nutritional status. [66] Therefore, enhanced protein support was considered crucial in managing the patient overall condition.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of DAIR in managing Candida parapsilosis-infected total knee arthroplasty with five-year follow-up: A case report and review of literature

Li,

Fan,

Zhang

et al. 2023

Medicine

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Rationale: Fungal periprosthetic joint infections (fPJIs) are relatively uncommon, accounting for approximately 1% of all PJIs. Revision surgery is typically recommended for fungal infections; however, the physical and financial impact on patients is significant. In this report, we present a case of fPJI successfully treated with debridement, antibiotics, and implant retention (DAIR) with a favorable outcome over a 5-year period. Patient Concern: A 56-year-old male patient presented with a non-healing surgical incision 1 week after undergoing primary total knee arthroplasty on the right side. Diagnosis: Microbiological culture of the wound effusion identified Candida parapsilosis. Postoperatively, the patient exhibited a significant decrease in serum albumin levels and poor glycemic control. Both C-reactive protein and erythrocyte sedimentation rate were elevated. Interventions: A comprehensive DAIR procedure was performed, along with continuous closed irrigation using fluconazole for 1 week. The patient received intravenous voriconazole for 4 weeks, followed by oral fluconazole for an additional 3 months. Outcomes: At 1- and 5-year follow-up appointments, the patient C-reactive protein and erythrocyte sedimentation rate levels were within normal limits, and there was no evidence of swelling, erythema, or tenderness in the right knee joint, indicating no signs of infection. Lessons: DAIR is an effective treatment for early fPJIs, and continuous closed irrigation may provide specific advantages. The patient nutritional status plays a crucial role in the management of periprosthetic infections.

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Section: Discussionmentioning

confidence: 99%

“…Hypoalbuminemia may contribute to increased failure rates in treatment outcomes. [28][29][30] Furthermore, the majority of PJI cases are associated with bacterial infections, predominantly involving Staphylococcus species. Fungal PJI is considerably rarer, accounting for approximately 1% of the total number of PJI cases.…”

Section: Etiologymentioning

confidence: 99%

Efficacy of DAIR in managing Candida parapsilosis-infected total knee arthroplasty with five-year follow-up: A case report and review of literature

Li,

Fan,

Zhang

et al. 2023

Medicine

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“…1,6,18,19 Host factors, such as male sex, advanced age, smoking, obesity, hypoalbuminemia, and medical comorbidities including diabetes mellitus, rheumatologic conditions, heart, or psychiatric and coagulation disorders have also been linked to TSE failure. [7][8][9][10][11]19 When considering laboratory tests taken at the time of diagnosis, a higher c-reactive protein (CRP) at the time of diagnosis has been shown to be associated with a higher probability of reinfection. 5 Data on intraoperative surgical technique to prevent PJI recurrence when performing TSE are limited.…”

Section: Discussionmentioning

confidence: 99%

“…Although this treatment has been successful relative to alternative procedures, studies have reported a failure rate ranging from 10.7% to 40% at short term. [4][5][6][7] Recurrence of PJI after failed TSE is exceedingly difficult to treat with frequent conversion to girdlestone or joint arthrodesis.…”

mentioning

confidence: 99%

“…These include sex, obesity, smoking, prior revision surgery, resistant staphylococcus aureus infection, and medical comorbidities including cardiac disease, psychiatric disorders, and hypoalbuminemia. [5][6][7][8][9][10][11][12] Although multiple studies have looked at preoperative factors associated with PJI recurrence, data on intraoperative risk factors are more limited. The importance of sterility of surgical drapes, instruments, gloves, and gowns has been wellestablished in prevention of PJI in the primary setting.…”

mentioning

confidence: 99%

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Dual Surgical Setup Associated with Reduced Infection Recurrence for Hip and Knee Arthroplasty After Two-Stage Exchange

Mittal,

Blackburn,

Katakam

et al. 2023

J Am Acad Orthop Surg

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Introduction: Two-stage exchange (TSE) is the gold standard for the treatment of chronic periprosthetic joint infection (PJI) after total joint arthroplasty of the hip and knee in the United States. Failure of treatment can have devastating consequences for the patient, including poor functional outcomes, multiple further surgeries, and increased mortality. Several factors associated with infection recurrence have previously been identified in the literature. The purpose of this study was to evaluate whether the use of a dual surgical setup was associated with reduced risk of recurrence after TSE for PJI. Methods: A retrospective study was conducted between January 2000 and December 2021 to isolate patients who underwent TSE after total joint arthroplasty of the hip and knee. Failure was defined as infection recurrence requiring surgical intervention. Demographic factors (age, sex, body mass index, smoking status, American Society of Anesthesiologists status), preoperative comorbidities (hypertension, cardiac disease, diabetes status, depression diagnosis, pulmonary disease), operating surgeon, single versus dual setup, hospital setting, use of long-term antibiotics postoperatively after TSE, aspiration data, and infecting organism were compared between cohorts using multivariate regression analysis. Results: A total of 134 patients were identified who underwent TSE after diagnosis of PJI. The mean follow-up was 67.84 (range, 13 to 236) months. Dual setup (odds ratio, 0.13; confidence interval, 0.02 to 0.52; P = 0.0122) was found to be an independent predictive variable associated with a lower risk of infection recurrence. Conclusion: Utilization of a dual surgical setup is a low-cost modifiable risk factor associated with a lower risk of recurrence of after TSE of the hip and knee for PJI.

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Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

Rodríguez-Merchán,

Encinas-Ullán,

Ruiz-Pérez

et al. 2024

Advances in Revision Total Knee Arthroplasty

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Hypoalbuminemia Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee

Cited by 11 publications

References 18 publications

Efficacy of DAIR in managing Candida parapsilosis-infected total knee arthroplasty with five-year follow-up: A case report and review of literature

Efficacy of DAIR in managing Candida parapsilosis-infected total knee arthroplasty with five-year follow-up: A case report and review of literature

Dual Surgical Setup Associated with Reduced Infection Recurrence for Hip and Knee Arthroplasty After Two-Stage Exchange

Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

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