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Updated: Jul 30, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
The Outcomes of Hip and Knee Fungal Periprosthetic Joint Infections: A Retrospective Cohort Study
Robert A McCulloch1, Antony J Palmer2, James Donaldson1
1Royal National Orthopaedic Hospital, Stanmore, UK.
Background:
Fungal infections are a rare cause of periprosthetic joint infection (PJI), identified in 1% of all of these cases. Outcomes are not well-established due to small cohort sizes in the published literature. The aims of this study were to establish the patient demographics and infection-free survival of patients presenting to 2 high-volume revision arthroplasty centers who had fungal infection of either a hip or knee arthroplasty. We sought to identify risk factors for poor outcomes.
Methods:
A retrospective analysis was performed of patients at 2 high-volume revision arthroplasty centers who had confirmed fungal PJI of the total hip arthroplasty (THA) and total knee arthroplasty (TKA). Consecutive patients treated between 2010 and 2019 were included. Patient outcomes were classified as infection eradication or persistence. A total of 67 patients who had 69 fungal PJI cases were identified. There were 47 cases involving the knee and 22 of the hip. Mean age at presentation was 68 years (THA mean 67, range 46 to 86) (TKA mean 69, range, 45 to 88). A history of sinus or open wound was present in 60 cases (89%) (THA 21 cases, TKA 39 cases). The median number of operations prior to the procedure at which fungal PJI was identified was 4 (range, 0 to 9), THA 5 (range, 3 to 9), and TKA 3 (range, 0 to 9).
Results:
At a mean follow-up 34 months (range, 2 to 121), remission rates were 11 of 24 (45%) and 22 of 45 (49%) for hip and knee, respectively. There were 7 TKA (16%) and 1 THA cases (4%) that failed treatment resulting in amputations. During the study period, 7 THA and 6 TKA patients had died. Two deaths were directly attributable to PJI. Patient outcome was not associated with the number of prior procedures, patient comorbidities, or organisms.
Conclusion:
Eradication of fungal PJI is achieved in less than half of patients, and outcomes are comparable for TKA and THA. The majority of patients who have fungal PJI present with an open wound or sinus. No factors were identified that increase the risk of persistent infection. Patients who have fungal PJI should be informed of the poor outcomes.
Insights
Fungal periprosthetic joint infections (PJI) are rare and difficult to treat, with less than half of patients achieving remission. Outcomes for hip and knee fungal PJI are similar, and risk factors for poor outcomes were not identified.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Mycology
Background:
- Fungal periprosthetic joint infection (PJI) is a rare complication of arthroplasty, accounting for only 1% of cases.
- Published literature on fungal PJI outcomes is limited due to small patient cohorts.
- This study aimed to define patient demographics and infection-free survival in fungal hip and knee arthroplasty infections.
Purpose of the Study:
- To establish patient demographics and infection-free survival for fungal periprosthetic joint infections (PJI) of the hip and knee.
- To identify potential risk factors associated with poor outcomes in fungal PJI.
- To provide insights into the management and prognosis of fungal PJI.
Main Methods:
- Retrospective analysis of patients with confirmed fungal PJI at two high-volume revision arthroplasty centers between 2010 and 2019.
- Inclusion criteria: confirmed fungal PJI in total hip arthroplasty (THA) or total knee arthroplasty (TKA).
- Outcomes were classified as infection eradication or persistence; patient demographics and prior surgical history were recorded.
Main Results:
- A total of 67 patients (69 fungal PJI cases: 47 TKA, 22 THA) were analyzed with a mean follow-up of 34 months.
- Remission rates were 45% for hip and 49% for knee PJI.
- Treatment failure occurred in 16% of TKA and 4% of THA cases, leading to amputation in some instances. Two deaths were directly attributed to PJI.
Conclusions:
- Fungal PJI eradication is achieved in less than half of patients, with comparable outcomes for total knee arthroplasty (TKA) and total hip arthroplasty (THA).
- The majority of patients presented with an open wound or sinus, but no specific risk factors for persistent infection were identified.
- Patients diagnosed with fungal PJI should be counselled regarding the generally poor prognosis and outcomes.
