Systemic Review of Published Literature on Candida Infection Following Total Hip Arthroplasty

Abstract

Candida species (Candida spp.) infection following total hip arthroplasty (THA) is a rare but potentially devastating complication. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of Candida spp. infection after THA. We conducted a systemic review of the literature and pooled analysis of Candida spp. infection after THA published between 1950 and 2014. A total of 20 articles with 37 patients were identified. Median time between THA and readmission for Candida spp. infection was 25 months (range 0.5-184 months). Thirty-two patients (87%) underwent removal of the prosthesis for initial surgical treatment. All patients were treated with systemic antifungal medication therapy for various durations after the surgical procedure or primary therapy without surgical procedures except for one patient who was treated with only amphotericin B joint cavity irrigation after removal of the prosthesis. Relapse of the infection occurred in three patients who had retention of the original prosthesis. There were three deaths related to the Candida spp. infection following THA owing to uncontrolled Candida spp. infection and deteriorating candidemia sepsis. Of note, among 15 patients who underwent two-stage exchange arthroplasty, there was one patient (7%) who developed complication (death) while other 14 patients had uncomplicated recovery. In conclusion, surgical debridement with removal of the original prosthesis or two-stage exchange arthroplasty with combination of adequate systemic antifungal therapy is highly recommended in the treatment of Candida spp. infection following THA.

Efficacy of intra-articular magnesium for postoperative analgesia in total hip arthroplasty

“…In recent years, as a result of increasing numbers of osteoarthritis cases and other degenerative disorders of the joint, THA is being widely performed and has been demonstrated to be a highly successful surgical intervention (16,17). Although this procedure is effective, it is often associated with a delayed rehabilitation and prolonged hospitalization, and is accompanied by severe pain during the early postoperative period.…”

Infecção por espécies de Candida em próteses articulares: revisão da literatura e caracterização clínica dos casos conduzidos no Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo

“…Kim et al (76) não determinam critérios de inclusão específicos quanto ao diagnóstico de infecção em prótese articular e incluem apenas pacientes com infecção em topografia de quadril e apenas casos com etiologia por Candida spp. relatando ao final um total de 37 pacientes.…”

“…A idade em que ocorreu o diagnóstico da infecção variou entre 65 e 69 anos nas revisões recentes (74)(75)(76)(77) enquanto nesta revisão a média foi de 67,2 anos estando em concordância com os resultados já publicados na literatura.…”

“…A distribuição entre os sexos foi igualitária com discreto predomínio de acometimento no sexo feminino (51%) nesta revisão e para Jakobs et al (74) porém outras publicações relatam prevalência de até 63% do sexo feminino em suas casuísticas (75)(76)(77) .…”

“…Nesta revisão foi encontrada a presença de ao menos um fator de risco para infecção fúngica em 64,9% dos pacientes. Outras revisões relatam a presença de ao menos um fator de risco entre 60 e 69% (74)(75)(76)(77) porém para Kuiper et al (73) este valor pode chegar a 90%.…”