Fungal periprosthetic joint infection after total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Medical Microbiology

Background:

• Total knee replacement (TKR) is a common procedure for severe knee joint disease.
• Periprosthetic joint infection (PJI) is a significant cause of TKR failure.
• Fungal PJI is uncommon but may be increasing in incidence, particularly in high-risk patients.

Observation:

• Two cases of late-onset fungal PJI (Candida spp.) presented with pain and inflammation six years post-TKR.
• Patients underwent a two-stage surgical protocol involving prosthesis removal, debridement, and antibiotic treatment.
• The second stage included prosthesis reimplantation after successful infection control.

Findings:

• The study details a successful two-stage treatment for fungal PJI.
• Identification of the specific fungal organism (Candida spp.) guided targeted antifungal therapy.
• This approach led to successful infection eradication and prosthesis reimplantation.

Implications:

• The findings suggest a potential treatment pathway for rare fungal PJIs following TKR.
• A structured, two-stage surgical approach can be effective in managing these challenging infections.
• Further research and established guidelines are needed for optimal management of fungal PJI.