May one-stage exchange for Candida albicans peri-prosthetic infection be successful?

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Mycology

Background:

• Fungal periprosthetic joint infections (PJI) are rare but challenging to treat, often requiring complex surgical interventions.
• The standard treatment for bacterial PJI is two-stage exchange arthroplasty, but its efficacy for fungal PJI is less established.
• Preoperative identification of the causative fungal organism is typically considered crucial for successful treatment outcomes.

Observation:

• This study presents two cases of successful one-stage total joint exchange for fungal PJI caused by Candida albicans.
• The causative pathogen, Candida albicans, was identified intraoperatively, meaning treatment proceeded without prior knowledge of the fungal infection.
• Both patients remained infection-free for two years post-surgery.

Findings:

• One-stage revision arthroplasty for Candida albicans PJI can achieve successful outcomes even when the infection is not identified preoperatively.
• This approach challenges the notion that preoperative diagnosis is essential for favorable results in fungal PJI.
• The study demonstrates the feasibility and success of a less conventional treatment strategy.

Implications:

• One-stage revision offers potential benefits over two-stage exchange, including reduced hospital stay, faster rehabilitation, and improved functional outcomes.
• These findings suggest that one-stage revision may be a viable and effective option for managing Candida albicans PJI, potentially reducing treatment costs and patient morbidity.
• Further research into one-stage revision strategies for fungal PJI is warranted to establish its role in the treatment algorithm.