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Prosthetic knee Candida parapsilosis infection
1Department of Orthopaedic Surgery, Fukui Medical School, Shimoaizuki, Japan.
Abstract:
We report a 77-year-old man who developed Candida parapsilosis infection following total knee arthroplasty. Knee joint effusion was noted 2 weeks after surgery, and repeated cultures of aspirated fluid established the diagnosis of Candida parapsilosis infection 4 weeks after surgery. Treatment consisted of debridement and lavage of the involved joint together with continuous irrigation with fluconazole for 4 weeks, followed by oral fluconazole for another 6 months. At 3 years follow-up, the patient was doing well and radiological examination of the affected knee showed a firm attachment of the prosthesis. We suggest that early identification of the causative organism followed by continuous irrigation and use of appropriate antifungal medication may prevent joint instability and spares the removal of the prosthesis.
Insights
A Candida parapsilosis infection after knee replacement surgery was successfully treated. Early diagnosis and antifungal irrigation prevented prosthesis removal and joint instability.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
Background:
- Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis.
- Prosthetic joint infections (PJIs) are a serious complication following TKA.
- Candida species, though less common than bacterial pathogens, can cause PJIs.
Observation:
- A 77-year-old male developed knee joint effusion two weeks post-TKA.
- Cultures of aspirated joint fluid confirmed Candida parapsilosis infection four weeks after surgery.
- The patient presented with signs of prosthetic joint infection.
Findings:
- Treatment involved surgical debridement and lavage.
- Continuous intra-articular fluconazole irrigation was administered for four weeks.
- Systemic oral fluconazole was given for six months post-irrigation.
- The patient achieved a favorable outcome with stable prosthesis fixation at three-year follow-up.
Implications:
- Early identification of Candida parapsilosis is crucial for effective PJI management.
- Combined surgical intervention with targeted antifungal therapy, including intra-articular irrigation, can be highly effective.
- This approach may help preserve the prosthesis and prevent long-term joint instability in TKA patients.
- Highlights the importance of considering fungal pathogens in PJI diagnosis and treatment strategies.