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Infectious Complications Following Primary Metacarpophalangeal or Proximal Interphalangeal Arthroplasty
Adam Schluttenhofer, BS
1; Matthew Rode, BS, MS
1; Marco Rizzo, MD
2; Peter Murray, MD
31Mayo Clinic Alix School of Medicine, Rochester, MN; 2Division of Hand Surgery, Mayo Clinic, Rochester, MN; 3Department of Orthopedic Surgery/Division of Hand Surgery, The Mayo Clinic, Jacksonville, FL
Introduction: Periprosthetic joint infection (PJI) is a devastating complication that has been well-characterized in the setting of large joint arthroplasty. The incidence, predisposing factors, presenting features, and management of PJI remain largely unknown for metacarpophalangeal (MCP) and proximal interphalangeal (PIP) arthroplasty.Materials & Methods: We performed a retrospective review of 1418 primary MCP or PIP arthroplasties performed at a single institution from 1991-2020 with a minimum of 180 days of revision-free follow-up (mean 9.0 years). Infectious complications were identified and classified as either PJI or superficial infection. Each infectious complication was further reviewed to gather details on its presentation and management. We also assessed differences in select demographics, past medical history, and surgical characteristics between infected and non-infected joints. Results: There were 6 digits that developed PJI (0.4%), and 10 digits that developed superficial infection (0.7%). Median time to PJI was 91.5 days, with 4 of 6 infections occurring within the first 100 days post-operatively. PJI commonly presented without systemic symptoms or significant increases in leukocyte count, C-reactive protein, or erythrocyte sedimentation rate. The most commonly cultured organism was Staphylococcus aureus (4 of 6). All patients with PJI received IV antibiotics. The most common surgical intervention for PJI was implant removal without reimplantation (4 of 6). There were no reinfections after a mean follow-up of 7.6 years beyond surgical intervention for PJI. Superficial infections were commonly treated with IV antibiotics (5 of 10), and all patients were treated with oral antibiotics after discharge and recovered without further manipulation of their implant. Conclusions: PJI is a rare complication following MCP or PIP arthroplasty. It commonly presents without systemic symptoms or elevated inflammatory markers and is frequently caused by Staphylococcus aureus. More work is needed to provide validated criteria for the diagnosis of PJI in the hand and better understand its optimal management.
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