Treatment of Candida Infection after TKA

PURPOSE: We wanted to review the clinical results of staged reimplantation in patients who had candidal infection after total knee arthroplasty. MATERIALS AND METHODS: We reviewed five patients who had a candidal prosthetic knee infection, as was assessed by synovial fluid culture. Amphotericin B was intravenously administrated to all five patients during the postoperative period for six weeks and followed for at least twelve months. We carried out two-stage re-implantations with using antifungal agent-impregnated bone cement. Whether or not infection recurred was evaluated according to the symptoms and radiologic and hematologic studies. The clinical results were analyzed on the basis of the range of motion and hospital for special surgery (HSS) score. RESULTS: The final review showed that all of the symptoms disappeared. We could not find any loosening on the radiologic studies and all five patients had normal C-reactive protein values on serological exams. The mean postoperative range of motion was 1degrees (range: 0~5)~99degrees (range: 70~130) and the mean HSS score improved from 49.4 (range: 44~64) points to 73 (range: 65~90) after the re-implantation. CONCLUSION: We successfully controlled five candidal prosthetic knee infections by removing the components in conjunction with using an antifungal- impregnated bone cement and staged re-implantation after a 6 week course of intravenous antifungal drugs.

Validity of Repeated MRI in Degenerative Lumbar Disease with Conservative Management / 대한정형외과학회잡지

PURPOSE: This study examined the value and indications of repeated MRI in degenerative lumbar diseases under conservative management by comparing the primary MR and repeated MR images with respect to the symptomatic and radiological changes. MATERIALS AND METHODS: Seventy patients with degenerative lumbar disease under conservative management underwent repeat MRI. Five MRI findings, including disc, foramen, facet joint, nerve root, and ligamentum flavum, were used to examine the difference between the initial and repeat MRI. The severity was graded using a four-point scale for each item. The patients were divided into 3 groups in order to compare the radiological changes and symptomatic changes, as follows; Group I no change from the initial symptoms (38 cases), Group II aggravation of the initial pain (18 cases), and Group III aggravation of the initial neurology or the development of a new neurology (14 cases). RESULTS: The mean scores of each item the disc, foramen, facet joint, nerve root and ligamentum flavum increased from 1.76, 1.31-1.79, 1.71, and 1.47, respectively, to 1.90, 1.47, 1.80, 1.79, and 1.53, respectively. Group III showed the greatest proportion of cases with an increasing grading score (78%, 11 cases) only the disc was significant. CONCLUSION: Repeat MRI in degenerative lumbar disease under conservative management was found to be valuable only in cases with aggravated neurological symptoms, and was not relevant in cases with persistent symptoms or aggravated pain alone.