Daily Low-Dose Intra-Articular Povidone-Iodine Salvage of Refractory Fungal Total Knee Arthroplasty Infection: A Case...

Area of Science:

• Orthopedic surgery
• Infectious diseases
• Medical device infections

Background:

• Periprosthetic joint infection (PJI) is a serious complication of joint replacement surgery.
• Refractory fungal PJI poses a significant treatment challenge, often requiring multiple interventions.
• Standard treatments for fungal PJI can be ineffective, leading to high rates of morbidity and implant loss.

Purpose of the Study:

• To evaluate the efficacy of intra-articular povidone-iodine instillation as a salvage therapy for refractory fungal PJI.
• To report a case of successful management of Candida parapsilosis PJI after total knee arthroplasty.

Main Methods:

• A 74-year-old female patient with recurrent Candida parapsilosis PJI after total knee arthroplasty was treated.
• Standard treatments including debridement, implant removal, and antifungal therapy failed.
• Daily intra-articular low-dose povidone-iodine instillation was administered as a salvage approach.

Main Results:

• Intra-articular povidone-iodine instillation achieved infection control without reported adverse events.
• Following a drug holiday and revision arthroplasty, the patient achieved independent ambulation.
• No recurrence of infection was observed at a 2-year follow-up.

Conclusions:

• Repeated low-dose povidone-iodine instillation can be a viable salvage option for patients with refractory fungal PJI.
• This approach may help avoid amputation and salvage infected joint prostheses.
• Further research is warranted to establish the role and safety of povidone-iodine in managing fungal PJI.