Implant-associated infection (IMTI) in long-term, well-fixed implants.

BACKGROUND

Orthopedic device infections caused by , including Periprosthetic joint infection (PJI), are rare and peculiar due to its poor adherence to implant surface and weak ability of biofilm formation. We present successful treatment of 2 cases of implant associated infection (IMTI) by meticulous surgical debridement and long-term anti-tubercular chemotherapy with retention of implant.

CASE DESCRIPTIONS

: A case of Culture-Negative PJI, 4 years after left total hip replacement (THR) caused by . The patient presented with acute onset (<7 days) low grade fever and development of discharging sinus from the site of left surgical scar mark. A patient with Kuntscher nailing done for open fracture right femur 22 years ago presented to clinic with complaints of discharging sinus (<7 days) from the surgical scar mark on right side. Both patients had negative cultures on presentation and underwent meticulous debridement with implant retention. Intra-operative samples were positive for on CB-NAAT and histopathology. They underwent successful treatment with 18 months of Anti Tubercular Treatment (ATT) without any relapse at 2 year-follow-up.

CONCLUSION

Atypical, late onset discharging sinus with negative cultures should raise suspicion of IMTI. Intra-operative deep tissue samples should be analyzed for CB-NAAT for and histopathological analysis in all these cases. Meticulous debridement with 18 months chemotherapy poses viable option for successful treatment of IMTI, allowing retention of prosthesis.