Related Experiment Video
Updated: Jul 30, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Treatment Outcomes of Fungal Periprosthetic Joint Infection
Carl L Herndon1, Taylor M Rowe2, Rory W Metcalf2
1Columbia University Irving Medical Center, New York, New York.
Background:
Periprosthetic joint infection (PJI) continues to challenge surgeons and patients. The burden of fungal organisms may represent approximately 1% of all PJI. Additionally, fungal PJI is difficult to treat. Most available case series are small and report poor success rates. Fungi are opportunistic pathogens and patients who have fungal PJI are believed to be immunocompromised. Additionally, fungal biofilms are more complex than those formed by other pathogens and confer additional drug resistance. Due to these factors, treatment failure is common.
Methods:
A retrospective review of our institutional registry was performed to identify patients treated for fungal PJI. There were 49 patients identified with 8 excluded for not having follow-up, which left 22 knees and 19 hips for analyses. Demographics, clinical characteristics, and surgical details were collected. The primary outcome was failure defined as reoperation for infection following the index surgery for fungal PJI within 1 year of the index surgery.
Results:
Failure occurred in 10 of 19 knees and 11 of the 22 hips. A higher proportion of patients who have extremity grade C failed treatment, and every patient who failed was host grade 2 or 3. The average number of prior surgeries and time from resection to reimplantation were similar between groups.
Conclusion:
To our knowledge, this represents the largest cohort of fungal PJIs reported in the literature to date. This data supports other literature in that failure rates were high. More study is needed to further understand this entity and improve care for these patients.
Insights
Fungal periprosthetic joint infection (PJI) has high failure rates, with nearly half of treated knees and hips requiring reoperation within a year. Immunocompromised patients and those with severe extremity damage faced worse outcomes.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Mycology
Background:
- Fungal periprosthetic joint infection (PJI) is a rare but challenging complication.
- Fungal PJI exhibits high treatment failure rates due to drug-resistant biofilms and potential patient immunocompromise.
Purpose of the Study:
- To analyze treatment outcomes in a large cohort of patients with fungal PJI.
- To identify factors associated with treatment failure in fungal PJI.
Main Methods:
- Retrospective review of an institutional registry of patients treated for fungal PJI.
- Analysis of 41 patients (22 knees, 19 hips) with a primary outcome of reoperation for infection within one year.
Main Results:
- High failure rates observed: 10 of 19 knees and 11 of 22 hips failed treatment.
- Treatment failure was more common in patients with extremity grade C and host grade 2 or 3.
Conclusions:
- This study represents the largest reported cohort of fungal PJI to date.
- High failure rates in fungal PJI confirm existing literature, highlighting the need for further research and improved treatment strategies.
Related Concept Videos
01:18Endocarditis III: Medical Management
01:29Endocarditis IV: Nursing Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:17Pericarditis III: Medical Management