Related Experiment Video
Updated: Apr 14, 2026
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review
Oliver Jakobs1, Benjamin Schoof1, Till Orla Klatte2
1Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany.
Abstract:
Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.
Insights
Fungal periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is rare but serious. This review of 45 cases highlights Candida as the main pathogen and discusses treatment strategies, with two-stage revision being preferred.
Area of Science:
- Orthopedics
- Infectious Diseases
- Mycology
Background:
- Fungal periprosthetic joint infection (PJI) is a rare but severe complication following total knee arthroplasty (TKA).
- A standardized treatment protocol for fungal PJI after TKA is currently lacking.
- This systematic review addresses the diagnostic and therapeutic challenges of fungal PJI in TKA patients.
Purpose of the Study:
- To systematically review and analyze diagnostic, medical, and surgical treatment strategies for fungal periprosthetic joint infection (PJI) following total knee arthroplasty (TKA).
- To identify the most common fungal pathogens and evaluate treatment outcomes in a cohort of TKA patients with fungal PJI.
Main Methods:
- Systematic review of 36 studies reporting 45 cases of fungal PJI after TKA.
- Analysis of pre-, intra-, and postoperative diagnostic, medical, and surgical interventions.
- Focus on pathogen identification, antifungal therapy, and surgical procedures.
Main Results:
- Candida species were the most frequent pathogen, accounting for approximately 80% of cases.
- Systemic antifungal therapy was universally administered, while local antifungal therapy showed limited relevance.
- Two-stage revision (resection arthroplasty with delayed re-implantation) was the preferred surgical approach, though treatment varied significantly.
- Outcomes were moderate, with 11 cases of recurrent fungal PJI and 5 cases of subsequent bacterial PJI.
Conclusions:
- Fungal PJI following TKA requires a comprehensive management approach, integrating systemic antifungal treatment with surgical intervention.
- Two-stage revision arthroplasty appears to be the most effective surgical strategy, despite heterogeneous approaches observed in current literature.
- Further research is needed to establish standardized treatment guidelines for this devastating complication.
