| Abstract [eng] |
Aim. Review the literature to understand the etiology, risk factors, clinical manifestations of periprosthetic infection, discuss diagnostic and treatment options and to describe a complex clinical case of this infectious complication in orthopedics. Methods. The literature search was conducted using the PubMed database. The selection criteria for publications were articles in English language published between the years of 1999 and 2025. Based on the selection criteria and predefined keywords, 53 scientific articles were selected from the PubMed database for the literature review. The Zotero bibliography management software was used for data storage. Case report. In 2020, a 70-year-old patient underwent primary right knee replacement surgery for osteoarthritis at the Kaunas Clinics of the Lithuanian University of Health Sciences, however, the postoperative course was complicated by a periprosthetic infection in the operated joint. A month later, a revision surgery was performed – the prosthesis was removed and a temporary prosthesis was implanted. A revision surgery was performed one month later – the prosthesis was removed and a temporary prosthesis was implanted. Another month later, after the periprosthetic infection had healed, the patient underwent a third surgery, during which a revision knee prosthesis was implanted. Following this surgery, the patient experienced pain, swelling, and limited mobility in the operated knee. A dislocation of the prosthesis component and a periprosthetic fracture were diagnosed, leading to another revision surgery, during which a hinged prosthesis was implanted. When signs of infection appeared, debridement was performed and the plastic liner was replaced. In 2021, a recurrent periprosthetic infection was diagnosed at Vilnius University Hospital, microbiological testing identified the bacterium Enterococcus faecalis, which was resistant to Vancomycin. In 2022, a sixth surgery was performed – removal of the prosthesis, debridement, and implantation of a temporary cemented liner and treatment with Linezolid was initiated. Following the surgery, the patient received intensive care and was later transferred to the rehabilitation ward. Two months later, a physician’s consultation revealed an improvement in the patient’s condition and negative cultures, however, one month later, instability of the cemented insert fixation and deformation of the intramedullary nails were detected, so the patient underwent a revision surgery – a rotational endoprosthesis was implanted. The patient’s condition has improved, but mobility issues persist. Conclusions. This clinical case illustrates the complex interplay between infection, mechanical complications and the patient’s general condition during the course of treatment. In the presented case, the patient’s infection was recurrent, despite repeated revision surgeries of endoprosthesis, debridements or the implantation of temporary prostheses. The prolonged course of the disease led to significant functional impairments, including pain, limited range of motion and loss of mobility. The pathogen identified during the course of the infection, Enterococcus faecalis, which was resistant to Vancomycin, complicated the treatment of the infection and required targeted antibiotic therapy with Linezolid administered intravenously at 600 mg twice daily. Despite the final revision surgery, there remains a need for intensive rehabilitation and compensation for the patient’s leg function. |
