Treatment and Outcomes of Fungal Prosthetic Joint Infections: A Systematic Review of 225 Cases

Gonzalez, Marcos R; Bedi, Angad; Karczewski, Daniel; Calderón, Santiago A. Lozano

doi:10.1016/j.arth.2023.05.003

Cited by 12 publications

(8 citation statements)

References 42 publications

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“…Identification of the causative organism of the PJI before choosing the surgical strategy is critical, as previous research has reported that for certain MDR or XDR Gramnegative organisms, DAIR is associated with higher failure rates compared to two-stage revision, regardless of surgical timing [73]. Similar findings have been reported in fungal PJI, with DAIR being a risk factor for PJI recurrence compared to two-stage revision [64]. α Reflects data from the entire cohort study, not specific to this treatment strategy; β described by authors as one-stage, classified as DAIR plus since the stems were not revised; γ authors described that 44% (14/32) of the two-stage revisions had incomplete removal (at least one well fixed stem); δ authors assessed treatment success rate by surgery rather than by patient (restricted to the first treatment of the PJI).…”

Section: Debridement Antibiotics and Implant Retention (Dair)mentioning

confidence: 59%

“…While studies in conventional joint arthroplasty have highlighted worse outcomes in Gram-negative and fungal PJI [64,65], the impact of microorganism profile on treatment success rates of megaprostheses PJI remains unknown. Furthermore, the few studies available on the subject are characterized by a heterogeneous population and the lack of controlling for potential confounders [36,66,67].…”

Section: Microbiology Of Pji In Megaprosthesismentioning

confidence: 99%

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Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses—A Review of the Literature

Gonzalez,

Pretell-Mazzini,

Lozano-Calderon

2023

Antibiotics

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Prosthetic joint infection (PJI) is the most common mode of failure of megaprostheses, yet the literature on the topic is scarce, and studies report conflicting data regarding the optimal treatment strategy. Patients with megaprostheses PJI are often immunosuppressed, and surgeons must balance the trade-off between treatment efficacy and morbidity associated with the surgery aiming for infection eradication. Our review on megaprostheses PJI focuses on two axes: (1) risk factors and preventative strategies; and (2) surgical strategies to manage this condition. Risk factors were classified as either unmodifiable or modifiable. Attempts to decrease the risk of PJI should target the latter group. Strategies to prevent PJI include the use of silver-coated implants, timely discontinuation of perioperative antibiotic prophylaxis, and adequate soft tissue coverage to diminish the amount of dead space. Regarding surgical treatment, main strategies include debridement, antibiotics, implant retention (DAIR), DAIR with modular component exchange, stem retention (DAIR plus), one-stage, and two-stage revision. Two-stage revision is the “gold standard” for PJI in conventional implants; however, its success hinges on adequate soft tissue coverage and willingness of patients to tolerate a spacer for a minimum of 6 weeks. DAIR plus and one-stage revisions may be appropriate for a select group of patients who cannot endure the morbidity of two surgeries. Moreover, whenever DAIR is considered, exchange of the modular components should be performed (DAIR plus). Due to the low volume of megaprostheses implanted, studies assessing PJI should be conducted in a multi-institutional fashion. This would allow for more meaningful comparison of groups, with sufficient statistical power. Level of evidence: IV.

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Section: Debridement Antibiotics and Implant Retention (Dair)mentioning

confidence: 59%

Section: Microbiology Of Pji In Megaprosthesismentioning

confidence: 99%

Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses—A Review of the Literature

Gonzalez,

Pretell-Mazzini,

Lozano-Calderon

2023

Antibiotics

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“…We assessed the quality of the included studies using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist field. Ten of the 22 items of the STROBE checklist were used in accordance with previous studies in the orthopaedic literature [116][117][118][119][120] . Each item was graded on a scale of 0 to 2, with 2 points being used in well-described items, 1 point in partly described items, and 0 points in poorly described items.…”

Section: Assessment Of Study Qualitymentioning

confidence: 99%

Treatment and Outcomes of 4,973 Unicameral Bone Cysts

Ruiz-Arellanos,

Larios,

Inchaustegui

et al. 2024

JBJS Reviews

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» Unicameral bone cysts (UBCs) can increase the risk of pathologic fractures of both long and short bones. Although multiple treatments exist, data are conflicting regarding optimal management.» We sought to analyze treatment strategies for UBCs and their rates of successful treatment.» Success rates were analyzed according to treatment modality, with emphasis on filling techniques and/or decompression associated with curettage, and injection compounds.» Curettage with bone substitute and cyst decompression was identified as a highly successful technique for UBC treatment.» Decompressing the cyst wall after injection, regardless of the specific compound used, had a greater potential to enhance healing rates.» The management decision should be individually guided within the patient's context. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…For the 10 articles that did not use a comparator group, we used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist field in accordance with previous orthopaedic literature [49][50][51]. For this checklist, 10 of the 22 items were used.…”

Section: Assessment Of Study Quality Assessment and Risk Of Biasmentioning

confidence: 99%

Is Unplanned Excision of Soft Tissue Sarcomas Associated with Worse Oncological Outcomes?—A Systematic Review and Meta-Analysis

Larios,

Gonzalez,

Ruiz-Arellanos

et al. 2024

Cancers

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Background: Soft tissue sarcomas are a group of rare neoplasms which can be mistaken for benign masses and be excised in a non-oncologic fashion (unplanned excision). Whether unplanned excision (UE) is associated with worse outcomes is highly debated due to conflicting evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines. Main outcomes analyzed were five-year overall survival (OS), five-year local recurrence-free survival (LRFS), amputation rate and plastic reconstruction surgery rate. Risk ratios were used to compare outcomes between patients treated with planned and unplanned excision. Results: We included 16,946 patients with STS, 6017 (35.5%) with UE. UE was associated with worse five-year LRFS (RR 1.35, p = 0.019). Residual tumor on the tumor bed was associated with lower five-year LRFS (RR = 2.59, p < 0.001). Local recurrence was associated with worse five-year OS (RR = 1.82, p < 0.001). UE was not associated with a worse five-year OS (RR = 0.90, p = 0.16), higher amputation rate (RR = 0.77, p = 0.134), or a worse plastic reconstruction surgery rate (RR = 1.25, p = 0.244). Conclusions: Unplanned excision of Soft Tissue Sarcomas and the presence of disease in tumor bed after one were associated with worse five-year LRFS. Tumor bed excision should remain the standard approach, with special consideration to the presence of residual disease.

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Treatment and Outcomes of Fungal Prosthetic Joint Infections: A Systematic Review of 225 Cases

Cited by 12 publications

References 42 publications

Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses—A Review of the Literature

Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses—A Review of the Literature

Treatment and Outcomes of 4,973 Unicameral Bone Cysts

Is Unplanned Excision of Soft Tissue Sarcomas Associated with Worse Oncological Outcomes?—A Systematic Review and Meta-Analysis

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