Successful two-stage revision of Lactobacillus infection of a total knee arthroplasty and literature review.
BACKGROUND
Lactobacillus has been identified as the causative organism in only two total joint arthroplasties: one total hip arthroplasty (THA) and one total knee arthroplasty (TKA). The THA was a litigious case that was treated successfully with a one-stage revision, and the patient with the TKA ultimately required above-knee amputation. We present the first case report of a Lactobacillus infection of a TKA that was treated successfully with a two-stage revision TKA.


METHODS
Case report and literature review.


METHODS
While undergoing a revision left TKA for persistent pain, a 55-year-old Caucasian female was found to have a Lactobacillus infection by intra-operative culture. After an extended course of intravenous (IV) antibiotics, the patient underwent a successful two-stage revision of her prosthesis.


CONCLUSIONS
Lactobacillus has been appearing more frequently in the literature as a pathogen in patients with compromised immune systems. Orthopedic implant infection with Lactobacillus has only been reported twice, with poorly defined treatment regimens and inconsistent results in both cases. The present report provides orthopedic surgeons and infectious diseases specialists with a treatment algorithm consisting of a two-stage revision of a TKA and a second-line IV antibiotic regimen that may be able to eradicate a Lactobacillus infection of an orthopedic prosthesis with retention of the extremity containing the implant and re-implantation of a functioning prosthesis.
Department of Orthopaedics, Wayne State University School of Medicine , Detroit, Michigan.
Nathan
N
Jacobson
Michael
M
Milshteyn
Robert
R
Teitge
D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology*; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification*; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000382:microbiology*
D000900:Anti-Bacterial Agents