Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jan 21;11(1):20.
doi: 10.1186/s13256-016-1176-0.

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

Cory A Kwong  1 , Shannon K T Puloski  2 , Kevin A Hildebrand  3
Affiliations
Review

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

Cory A Kwong et al. J Med Case Rep. .

Abstract

Background: With improving surgical techniques for total elbow arthroplasty clinical outcomes have improved and its utilization continues to increase. Despite these advances, complication rates remain as high as 24%. Of these complications periprosthetic joint infection is one of the most common and morbid. The rheumatoid elbow remains a leading indication for total elbow arthroplasty. Patients with this condition frequently require immunosuppressive therapy, which places them at higher risk of both typical and atypical infections.

Case presentation: We present the case of a persistent, late-onset periprosthetic joint infection in a total elbow arthroplasty of a 64-year-old Caucasian woman with severe refractory rheumatoid arthritis. The offending pathogen, Aspergillus terreus, is previously unreported in the arthroplasty literature and grew concurrently with coagulase-negative staphylococcus. Eradication of the fungal and bacterial agents involved resection arthroplasty, serial debridement, and multiple courses of intravenous and oral antimicrobial therapy. Two attempts at reimplantation arthroplasty failed to eliminate the infection and our patient ultimately required definitive resection arthroplasty.

Conclusions: Arthroplasty in the rheumatoid elbow confers with it a high complication rate. Inflammatory disease and immunosuppressive drugs combined with the subcutaneous anatomy of the elbow contribute to the risk of infection. Fungal periprosthetic joint infection in the rheumatoid patient presents both diagnostic and therapeutic challenges. Fungal growth should always be treated and requires organism-specific antimicrobials in conjunction with surgical debridement. More literature is needed to determine the optimal treatment regimen for this devastating complication.

Keywords: Aspergillus terreus; Fungal; Infection; Periprosthetic joint infection; Resection arthroplasty; Revision; Rheumatoid arthritis; Total elbow arthroplasty.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Left total elbow arthroplasty showing well-fixed components
Fig. 2
Fig. 2
Left revision total elbow arthroplasty with cemented allograft prosthetic composite
Fig. 3
Fig. 3
Revision total elbow arthroplasty with new ulnar-sided insufficiency fracture
Fig. 4
Fig. 4
Left elbow resection arthroplasty
Fig. 5
Fig. 5
Left revision total elbow arthroplasty anteroposterior view
Fig. 6
Fig. 6
Left revision total elbow arthroplasty lateral view
See this image and copyright information in PMC

References

    1. Voloshin I, Schippert DW, Kakar S, Kaye EK, Morrey BF. Complications of total elbow replacement: a systematic review. J Shoulder Elbow Surg. 2011;20(1):158–68. doi: 10.1016/j.jse.2010.08.026. - DOI - PubMed
    1. Singh JA, Ramachandran R. Sex differences in characteristics, utilization, and outcomes of patient undergoing total elbow arthroplasty: a study of the US nationwide inpatient sample. Clin Rheumatol. 2016;35(3):723–731. doi: 10.1007/s10067-014-2778-9. - DOI - PMC - PubMed
    1. Kim JM, Mudgal CS, Konopka JF, Jupiter JB. Complications of total elbow arthroplasty. J Am Acad Orthop Surg. 2011;19(6):328–39. doi: 10.5435/00124635-201106000-00003. - DOI - PubMed
    1. Leblanc J, Puloski S, Hildebrand K. Interprosthetic humeral fracture revision using a tibial allograft total elbow prosthetic composite in a patient with hemophilia A: a case report. J Med Case Reports. 2012;6:319. doi: 10.1186/1752-1947-6-319. - DOI - PMC - PubMed
    1. Bariteau JT, Waryasz GR, McDonnell M, Fischer SA, Hayda RA, Born CT. Fungal osteomyelitis and septic arthritis. J Am Acad Orthop Surg. 2014;22(6):390–401. doi: 10.5435/JAAOS-22-06-390. - DOI - PubMed

MeSH terms

Substances