Prosthetic Joint Infection of a Revision Knee Arthroplasty with <i>Candida parapsilosis</i>

Keuning, Martine Christine; Moujahid, Aziz Al; Zijlstra, Wierd P

doi:10.1155/2019/3634519

Cited by 2 publications

(4 citation statements)

References 11 publications

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“…Table 1 summarizes the main characteristics of all reported cases of fungal PJI in revised knee arthroplasty. A total of 46 patients (17; 37% males) suffering fungal PJI occurring in revised knee arthroplasty, covering a 22-year period, were identified [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The studied population’s median age was 69 years [range = 27–84, interquartile range (IQR) = 10].…”

Section: Discussionmentioning

confidence: 99%

Fungal Prosthetic Joint Infection in Revised Knee Arthroplasty: An Orthopaedic Surgeon’s Nightmare

et al. 2022

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Fungal prosthetic joint infections (PJIs), despite the fact that they are rare, represent a devastating complication. Such infections in revised knee arthroplasties pose a unique surgical and medical challenge. A rare case of Candida parapsilosis PJI in revised knee arthroplasty is reported. Furthermore, a thorough review of all published fungal PJIs cases in revised knee arthroplasties is provided. A 72-year-old female with total knee replacement surgery due to osteoarthritis 10 years ago, followed by two revision surgeries six and two years ago due to aseptic loosening, presented with signs and symptoms of septic loosening of the knee components. Resection arthroplasty and cement-spacer placement was performed and periprosthetic tissue cultures yielded Candida parapsilosis. The patient was commenced on proper antifungal treatment (AFT) for six months and then the second stage of the revision surgery was performed successfully. From 2000 to 2022, a total of 46 patients with median age 69 years [interquartile range (IQR = 10)], suffering fungal PJI occurring in revised knee arthroplasty have been reported. The median time from initial arthroplasty to symptoms’ onset was 12 months (IQR = 14). Cultures of local material (52.2%) and histology (6.5%) were the reported diagnostic method, while Candida species were the most commonly isolated fungi. Regarding surgical management, two-stage revision arthroplasty (TSRA) was performed in most cases (54.3%), with median time-interval of six months (IQR = 6) between the two stages. Regarding AFT, fluconazole was the preferred antifungal compound (78.3%), followed by voriconazole and amphotericin B (19.6% each). The median duration of AFT was five months (IQR = 4.5). Infection’s outcome was successful in 38 cases (82.6%). Fungal PJIs, especially in revised knee arthroplasties, are devastating complications. A combination of AFT and TSRA seems to be the treatment of choice. TSRA in these cases poses a special challenge, since major bone defects may be present. Therapeutic procedures remain unclear, thus additional research is needed.

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Section: Discussionmentioning

confidence: 99%

Fungal Prosthetic Joint Infection in Revised Knee Arthroplasty: An Orthopaedic Surgeon’s Nightmare

et al. 2022

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“…Thus, evidence-based guidelines on the treatment of fungal PJIs have yet to be established[ 4 ]. The presence of a persistent fungal infection is thought to be a result of an often delayed diagnosis[ 5 , 6 ]. Several different treatment methods, including antifungal drugs, debridement with retained prosthesis, resection arthroplasty, one-stage or two-stage exchange arthroplasty and arthrodesis have been reported, with variable outcomes[ 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, No primary source of candidal infection was identified in our case. It should be noted that C. parapsilosis infections are characterized by the creation of highly resolute biofilms, making eradication of the mycotic infection a significant obstacle[ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Amphotericin B and fluconazole are the most commonly used antifungal drugs, but their side effects are greater while voriconazole and itraconazole are less toxic[ 12 ]. Keuning et al [ 6 ] recently reported a case of C. parapsilosis PJI following revision of TKA, successfully treated with a combination of voriconazole and micafungin. The lack of evidence regarding the choice of antifungals warrants further research in order to optimize treatment protocols for mycotic PJI.…”

Section: Discussionmentioning

confidence: 99%

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Candidal periprosthetic joint infection after primary total knee arthroplasty combined with ipsilateral intertrochanteric fracture: A case report

Xin¹,

Qing-shan²,

Zhang³

et al. 2020

WJCC

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BACKGROUND Candidal periprosthetic joint infection is a rare and difficult to diagnose complication of total knee arthroplasty. The treatment of such complications is inconclusive and may include prosthesis removal, debridement, arthrodesis, and extensive antifungal therapy to control the infection. CASE SUMMARY A 62-year-old male with a history of total knee arthroplasty (TKA) in his left knee presented with ipsilateral knee pain and a sinus discharge 20 mo after TKA. The patient was previously evaluated for left knee pain, swelling, and a transient fever one month postoperatively. Prothesis removal and insertion of a cement spacer were performed in a local hospital six months prior to the current presentation. Medical therapy included rifampicin and amphotericin which were administered for 4 wk following prosthesis removal. A second debridement was performed in our hospital and Candida parapsilosis was detected in the knee joint. Fourteen weeks following the latter debridement, the patient suffered a left intertrochanteric fracture and received closed reduction and internal fixation with proximal femoral nail anterotation. Two weeks after fracture surgery, a knee arthrodesis with autograft was performed using a double-plate fixation. The patient recovered adequately and was subsequently discharged. At the two-year follow-up, the patient has a stable gait with a pain-free, fused knee. CONCLUSION Fungal periprosthetic joint infection following TKA may be successfully and safely treated with prosthesis removal, exhaustive debridement, and arthrodesis after effective antifungal therapy. Ipsilateral intertrochanteric fractures of the affected knee can be safely fixated with internal fixation if the existing infection is clinically excluded and aided by the investigation of serum inflammatory markers.

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Prosthetic Joint Infection of a Revision Knee Arthroplasty with Candida parapsilosis

Cited by 2 publications

References 11 publications

Fungal Prosthetic Joint Infection in Revised Knee Arthroplasty: An Orthopaedic Surgeon’s Nightmare

Fungal Prosthetic Joint Infection in Revised Knee Arthroplasty: An Orthopaedic Surgeon’s Nightmare

Candidal periprosthetic joint infection after primary total knee arthroplasty combined with ipsilateral intertrochanteric fracture: A case report

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