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Case Reports
. 2021 Mar 25:8:163-170.
doi: 10.1016/j.artd.2021.02.009. eCollection 2021 Apr.

Eradicating Fungal Periprosthetic TKA "Super-infection": Review of the Contemporary Literature and Consideration of Antibiotic-Impregnated Dissolving Calcium Sulfate Beads as a Novel PJI Treatment Adjunct

Andrew P Kurmis  1   2
Affiliations
Case Reports

Eradicating Fungal Periprosthetic TKA "Super-infection": Review of the Contemporary Literature and Consideration of Antibiotic-Impregnated Dissolving Calcium Sulfate Beads as a Novel PJI Treatment Adjunct

Andrew P Kurmis. Arthroplast Today. .

Abstract

Fungal periprosthetic joint infections are an uncommon but potentially devastating complication of arthroplasty surgery. The concurrent presence of a coexistent bacterial pathogen-a so called "super-infection"-adds further complexity. With delays to definitive diagnosis and a large number of procedures before cure, the associated physical and psychological morbidity is considerable. Beyond this, the economic and resource burden can be substantial. This case report presents the successful rapid treatment of an atypical bacterial and fungal periprosthetic super-infection with two-stage revision surgery augmented with a commercially available dissolving calcium sulfate bead system permitting targeted local antifungal elution. While not the panacea for treatment, these beads provide another potentially useful tool in the atypical pathogen eradication armamentarium. Much research is still indicated to define the optimal care pathway for fungal periprosthetic super-infections.

Keywords: Calcium sulfate beads; Fungal PJI; Prosthetic joint infection; Super-infection.

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Figures

Figure 1
Figure 1
Index TKA. Advantim (Wright medical, Arlington, TN).
Figure 2
Figure 2
Preindex surgery native knee showing tricompartmental osteoarthritis and varus limb alignment.
Figure 3
Figure 3
Mobile eluting spacer first-stage revision TKA. NexGen CR (Zimmer Biomet, Warsaw, IN).
Figure 4
Figure 4
Repeat first-stage revision with polyethylene exchange and the addition of Stimulan (Biocomposites, Staffordshire, England) eluting calcium phosphate beads (triangular arrow) and intrameduallary paste (diamond arrow). NexGen CR (Zimmer Biomet, Warsaw, IN) implant construct.
Figure 5
Figure 5
Definitive (2nd stage) TKA construct. Uncemented Attune Revision System RP CRS (DePuy Synthes; Raynham, MA, USA).
See this image and copyright information in PMC

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References

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