Fungal peri-prosthetic joint infection after primary total knee replacement

Abstract

We retrospectively reviewed 30 two-stage revision procedures in 28 patients performed for fungal peri-prosthetic joint infection (PJI) after a primary total knee replacement. Patients were followed for at least two years or until the infection recurred. The mean follow-up for patients who remained free of infection was 4.3 years (2.3 to 6.1). Overall, 17 patients were assessed as American Society of Anesthesiologists grade 3 or 4. The surgical protocol included removal of the infected implant, vigorous debridement and insertion of an articulating cement spacer. This was followed by at least six weeks of antimicrobial treatment and delayed reimplantation in all patients. The mean interval between removal of the prosthesis and reimplantation was 9.5 weeks (6 to 24). After reimplantation, patients took antifungal agents orally for a maximum of six months. Two knees became reinfected at one and two months post-operatively, respectively: one of these subsequently required arthrodesis because of uncontrolled infection.Fungal PJIs can be treated successfully by removal of all infected material, appropriate antimicrobial treatment and delayed reimplantation.Peri-prosthetic joint infection (PJI) is one of the most serious complications of total knee replacement (TKR).

Prosthetic Joint Infection

“…Fewer than 1% of PJI cases are caused by fungi. Among these, Candida species are found in at least 80% of cases (238,239). Concomitant bacterial infection occurs in 15 to 20% of cases.…”

“…Concomitant bacterial infection occurs in 15 to 20% of cases. The individual Candida species may be related to geographic differences, with Candida albicans causing the majority of infections in one multicenter American study (239) and Candida parapsilosis being the most frequently isolated species in a singlecenter experience from Southeast Asia (238). Aspergillus species (239)(240)(241)(242), dimorphic fungi (243,244), pigmented yeast (239), dematiaceous fungi (239), and other filamentous fungi (245) have all been rarely reported in PJIs.…”

“…Infection with Candida species or fungal organisms is more appropriate for this strategy or permanent resection rather than implant retention (238,239,246,426). One study reported a success rate of 93% for infection control at short-term follow-up with 6 months of oral antifungal agents after reimplantation (238).…”

“…Infection with Candida species or fungal organisms is more appropriate for this strategy or permanent resection rather than implant retention (238,239,246,426). One study reported a success rate of 93% for infection control at short-term follow-up with 6 months of oral antifungal agents after reimplantation (238). However, this finding is in contrast to another similarly sized series that found that only two-thirds of patients undergoing resection for fungal PJI underwent reimplantation, with infection being controlled in fewer than half of them (239).…”

Aspergillus Sphenoiditis Associated with an Artificial Bone Graft Used for Transsphenoidal Surgery

“…Fungi can colonize implanted foreign bodies such as central venous catheters, pacemaker leads, and prosthetic joints, resulting in systemic complications. [8][9][10][11] Feely and Steinberg described two cases of Aspergillus infection caused by a transsphenoidal 90 Y pituitary implant mounted on stainless steel screws to destroy the pituitary by interstitial irradiation. 12) To the best of our knowledge, this is the first report of Aspergillus infection in an artificial bone graft.…”