Temporomandibular Prosthetic Joint Infections Associated with Propionibacterium acnes: A Case Series, and a Review of the Literature

Publication date: Available online 24 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ruba Khader, Joseph Tingey, Steven Sewall
IntroductionThe orthopedic literature has seen an increasing incidence of prosthetic joint infections (PJI) associated Propionibacterium acnes (P. acnes). These infections present significant diagnostic and management challenges to the treating surgeons. In this review, we report on the cases of P. acnes related temporomandibular prosthetic joint infections (TMJ PJI) that have been diagnosed and treated at our institution.MethodsFollowing IRB approval, we obtained information through a retrospective chart review. Records were retrieved from clinic visits between January 1^st 2010 and January 1^st 2015 using the appropriate ICD-9 codes. Data extracted included patient demographics, prostheses details, prosthetic infection history, interventions, diagnostic procedures, and culture processing methods.ResultsOf the 7 subjects that fit the search criteria, 4 subjects (1 with bilateral prostheses) had cultures positive for P. acnes. The 5 TMJ PJI's with cultures positive for P. acnes had tissue cultures obtained in the operating room and processed using Mass spectrometry. Symptoms identified in these 4 subjects were vague and included pain and intermittent swelling; clinical and radiographic findings were non-specific. Treatment regimens included oral and parenteral antibiotics and operative interventions.ConclusionsIn this case series, we report on the management of four cases of P. acnes related TMJ PJI. When patients with TMJ prostheses report vague symptoms of swelling and pain that do not fit the typical infection scenario, the surgeon should consider P. acnes as a source of infection. Additional case series and retrospective reviews will be necessary prior to developing prospective trials that will aid in the prevention and management of this infection.



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