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Staged reimplantation of total knee arthroplasty after Candida infection
1Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Abstract:
Prosthetic joint infection with Candida is uncommon. Only 28 cases have been reported in the English literature. Successful reimplantation after eradication of Candida infection has been reported in 3 hip joints and only 1 knee. We present the case of a 68-year-old woman with chronic Candida parapsilosis infection of a prosthetic knee joint. Removal of the prosthesis, thorough débridement, and antifungal therapy treated the infection successfully. Antifungal therapy included 6 weeks of parenteral administration of fluconazole followed by 4 weeks of oral fluconazole. The involved knee joint was reimplanted 3 months after initial treatment. The prosthetic joint was pain free and functioned satisfactorily during the ensuing 4 years. No recurrence of infection was noted. The principle in treating Candida prosthetic infection generally has been the same as that of bacterial prosthetic infection. In chronic cases, removal of implants, thorough débridement, and effective antifungal therapy are mandatory for the eradication of infection. Reimplantation of the prosthesis can be performed successfully in a staged surgical procedure with the interval between the 2 stages shortened to 3 months.
Insights
Chronic Candida parapsilosis prosthetic knee joint infections can be successfully treated. Surgical removal of the infected prosthesis followed by antifungal therapy and staged reimplantation offers a favorable long-term outcome.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Mycology
Background:
- Prosthetic joint infections (PJIs) caused by Candida species are rare, with limited reported cases.
- Successful reimplantation after Candida PJI is infrequently documented, particularly for knee joints.
Observation:
- A 68-year-old female presented with chronic Candida parapsilosis infection of a prosthetic knee joint.
- The infection was managed by prosthesis removal, extensive débridement, and a regimen of parenteral and oral fluconazole.
Findings:
- The patient's infection was successfully eradicated.
- The prosthetic knee was reimplanted three months after initial treatment.
- The reimplanted joint remained pain-free and functional for four years post-treatment without recurrence.
Implications:
- This case highlights that chronic Candida prosthetic joint infections can be effectively managed.
- A staged surgical approach with prosthesis removal, débridement, antifungal therapy, and timely reimplantation is a viable strategy.
- Shortening the interval to three months between prosthesis removal and reimplantation may be feasible for successful outcomes.
