Migrating Periprosthetic Infection from a Total Hip Replacement to a Contralateral Non-Operated Osteoarthritic Knee Joint

A B S T R A C T

Introduction: There is a paucity of published data on whether a treated infected arthroplasty is a risk factor for infection in another, non-operated joint. Contamination of a primary, arthritic, non-operated joint from an infected arthroplasty is a relatively rare entity.
Case: We report a case of migration of a pathogen (Enterococcus faecalis) from an infected prosthetic joint (hip) to the contralateral native joint (knee). Identification of the pathogen was made with PCR, by obtaining cultures during the implantation of the primary knee prosthesis.
Conclusion: Contamination of a primary, arthritic, non-operated joint from an infected arthroplasty has not been widely reported. Management of such cases is extremely challenging and without clear and established guidelines. Our experience shows that tissue samples should be taken intraoperatively and sent for cultures, so as to exclude contamination in those cases.

Keywords

PJI, Enterococcus faecalis, case report, migrating infection

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George A Komnos Antonios Papadopoulos Efstratios Athanaselis Theofilos Karachalios Sokratis E. Varitimidis

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References

1.     Kamath AF, Ong KL, Lau E, Chan V, Vail TP et al. (2015) Quantifying the Burden of Revision Total Joint Arthroplasty for Periprosthetic Infection. J Arthroplasty 30: 1492-1497. [Crossref]

2.     Ratto N, Arrigoni C, Rosso F, Bruzzone M, Dettoni F et al. (2016) Total knee arthroplasty and infection: how surgeons can reduce the risks. EFORT Open Rev 1: 339-344. [Crossref]

3.     Moyad TF, Thornhill T, Estok D (2008) Evaluation and management of the infected total hip and knee. Orthopedics 31: 581-588. [Crossref]

4.     Shahi A, Parvizi J (2015) Prevention of Periprosthetic Joint Infection. Arch Bone Jt Surg 3: 72-81. [Crossref]

5.     Richardson SS, Schairer WW, Sculco TP, Sculco PK (2019) Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty. J Bone Joint Surg Am 101: 112-118. [Crossref]

6.     Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD, INFORM Team (2016) Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. PLoS One 11: e0150866. [Crossref]

7.     Parvizi J, Gehrke T (2014) Definition of periprosthetic joint infection. J Arthroplasty 29: 1331. [Crossref]

8.     Tande AJ, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27: 302-345. [Crossref]

9.     Mihalko WM, Manaswi A, Cui Q, Parvizi J, Schmalzried TP et al. (2008) Diagnosis and treatment of the infected primary total knee arthroplasty. Instr Course Lect 57: 327-339. [Crossref]

10.  Komnos GA, Manrique J, Goswami K, Tan T, Restrepo C et al. (2020) Periprosthetic Joint Infection in Patients Who Have Multiple Prostheses in Place: What Should Be Done with the Silent Prosthetic Joints. J Bone Joint Surg Am 102: 1160-1168. [Crossref]

11.  Abblitt WP, Chan EW, Shinar AA (2018) Risk of Periprosthetic Joint Infection in Patients with Multiple Arthroplasties. J Arthroplasty 33: 840-843. [Crossref]

12.  Bedair H, Goyal N, Dietz MJ, Urish K, Hansen V et al. (2015) A History of Treated Periprosthetic Joint Infection Increases the Risk of Subsequent Different Site Infection. Clin Orthop Relat Res 437: 2300-2304. [Crossref]

13. Chalmers BP, Weston JT, Osmon DR, Hanssen AD, Berry DJ et al. (2019) Prior hip or knee prosthetic joint infection in another joint increases risk three-fold of prosthetic joint infection after primary total knee arthroplasty: a matched control study. Bone Joint J 101-B: 91-97. [Crossref]