Related Experiment Video
Updated: May 22, 2026
A Periprosthetic Joint Candida albicans Infection Model in Mouse
Published on: February 2, 2024
Fungal peri-prosthetic joint infection after primary total knee replacement
1Himchan Hospital, Joint & Arthritis Research, Department of Orthopaedic Surgery, 404-3 Mok-dong, Yangcheon-gu, Seoul 158-806, Korea.
Abstract:
We retrospectively reviewed 30 two-stage revision procedures in 28 patients performed for fungal peri-prosthetic joint infection (PJI) after a primary total knee replacement. Patients were followed for at least two years or until the infection recurred. The mean follow-up for patients who remained free of infection was 4.3 years (2.3 to 6.1). Overall, 17 patients were assessed as American Society of Anesthesiologists grade 3 or 4. The surgical protocol included removal of the infected implant, vigorous debridement and insertion of an articulating cement spacer. This was followed by at least six weeks of antimicrobial treatment and delayed reimplantation in all patients. The mean interval between removal of the prosthesis and reimplantation was 9.5 weeks (6 to 24). After reimplantation, patients took antifungal agents orally for a maximum of six months. Two knees became reinfected at one and two months post-operatively, respectively: one of these subsequently required arthrodesis because of uncontrolled infection. Fungal PJIs can be treated successfully by removal of all infected material, appropriate antimicrobial treatment and delayed reimplantation.
Insights
Treating fungal prosthetic joint infections (PJI) after knee replacement requires a two-stage revision. This involves implant removal, debridement, a cement spacer, and delayed reimplantation with antifungal medication, leading to successful outcomes.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Fungal prosthetic joint infection (PJI) is a challenging complication following total knee replacement.
- Effective treatment strategies for fungal PJI are crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of a two-stage revision protocol for treating fungal PJI after total knee replacement.
Main Methods:
- Retrospective review of 30 two-stage revision procedures in 28 patients with fungal PJI.
- Protocol included implant removal, debridement, articulating cement spacer, antimicrobial therapy, and delayed reimplantation.
- Patients followed for at least two years or until infection recurrence.
Main Results:
- Low reinfection rate (2 out of 30 knees) at one and two months post-operatively.
- Successful treatment achieved in most patients with a mean follow-up of 4.3 years for infection-free cases.
- Significant proportion of patients (17/28) had high American Society of Anesthesiologists (ASA) grades (3 or 4).
Conclusions:
- Two-stage revision surgery is a successful treatment for fungal PJI after total knee replacement.
- Key elements include complete removal of infected material, appropriate antimicrobial therapy, and delayed reimplantation.
- This approach offers a viable solution for managing complex fungal joint infections.
