Conversion From Knee Arthrodesis Back to Arthroplasty: A Particular Challenge in Combination With Fungal Periprosthetic Joint Infection

Arthroplast Today. 2020 Dec 5;6(4):1038-1044. doi: 10.1016/j.artd.2020.10.007. eCollection 2020 Dec.

Sven Frieler, Emre Yilmaz, Ryan Goodmanson, Yannik Hanusrichter, Thomas A Schildhauer, Hinnerk Baecker

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Abstract

A 58-year-old female treated at an outside facility with knee arthrodesis due to persistent periprosthetic joint infection fulfilled all prerequisites for a conversion back to arthroplasty, as part of a 2-stage revision. Owing to the detection of Candida parapsilosis, the treatment concept was converted to a three-stage procedure. A scheduled spacer exchange with additional amphotericin B-loaded polymethylmethacrylate was conducted as an intermediate revision before reimplantation. Conversion in the setting of fungal periprosthetic joint infection presents a challenge, and successful treatment hinges on the use of proper antifungal and antimicrobial protocols, advanced surgical techniques, and a multidisciplinary team approach. At the 3-year follow-up, successful infection eradication as measured by the Delphi-based consensus definition was achieved with a range of motion of 0°-100°.

Keywords: Arthroplasty; Conversion; Fungal periprosthetic joint infection; Knee arthrodesis; PJI; TKA; Three-stage revision; fPJI.

Figure 1

Conversion of an intramedullary knee arthrodesis (a) back to arthroplasty using a rotating hinge prosthesis (b).

Figure 2

Timeline: patient history. UKA, unicompartmental knee arthroplasty; DAIR, debridement, antibiotics and implant retention.

Figure 3

Poly(methyl methacrylate) spacer with carbon rods and a tube-to-tube connector.

Figure 4

NexGen RH Knee (Zimmer Biomet, Warsaw, IN) in (a)anteroposterior, (b) lateral, and (c) tangential views of the patella.

Figure 5

The three-stage exchange procedure.

Figure 6

Patient at 3-y follow-up, knee in anteroposterior position.; extension 0° and flexion 100° in the lateral position.