Infective spondylitis after periprosthetic joint infections: A case series report

An-Jhih Luo ； Fu-Cheng Kao ； An-Shun Tai ； Shih-Chen Fu ； Yu-Han Chang ； Pang-Hsin Hsieh ； Sheng-Hsuan Lin ； Sheng-Hsun Lee

《Formosan Journal of Musculoskeletal Disorders》 12卷3期 (2021/08) Pp. 109-116

https://doi.org/10.6492/FJMD.202108_12(3).0003

摘要

Introduction: Periprosthetic joint infection (PJI) is an intractable issue, and the delayed, incomplete, or interrupted treatment of PJI may result in infective spondylitis, which may need prolonged antibiotic treatment and incurred high medical expenses. Infective spondylitis after PJI was rare, and the outcomes of these patients are unknown. Purpose: We reviewed and analyzed cases of patients who developed infective spondylitis following PJI at our institution. Methods: We reviewed and included PJI patients who underwent surgical intervention at our institute from 2006 to 2019. Among these patients, we then identified patients who later developed infective spondylitis. We collected patient demographics, identified comorbidity and pathogen, performed resection arthroplasty, and documented and analyzed these outcomes. Results: Our study included 567 cases with PJIs. Seven patients suffered from infective spondylitis after an episode of PJI (1.2%) with median age of 72 years (range, 55-83). PJI was identified more often in knee joint (6 cases) than in hip joint (1 case). Mean C-reactive protein level during the diagnosis of PJI is 71.03 mg/ L (range, 14.62-204.50). Six patients presented with systemic inflammatory response syndrome. There are 5 patients with positive blood cultures. All 7 patients have undergone 2-stage resection arthroplasty; however, 4 patients underwent repeated 2-stage resection arthroplasty, and 2 patients with 3-stage resection arthroplasty or more. Four patients were successfully reimplanted with revision arthroplasty, but 3 patients kept the cement spacer permanently. Median duration of intravenous systemic antibiotics for PJI periods was 14 days (range, 7-35). Infective spondylitis occurred in lumbar spine (6 cases), and 1 case in thoracic spine. The median duration of development from PJI to infective spondylitis was 32 days (range, 9-889). Four patients suffered from recurrent PJI after infective spondylitis. Conclusion: Infective spondylitis following PJI results in a huge burden on patients and healthcare systems. Early identification of potential patients could provide timely medical treatment and prevent development of subsequent infective spondylitis.

關鍵字

bacteremia ； infective spondylitis ； periprosthetic joint infection ； resection arthroplasty ； sepsis