J Knee Surg 2010; 23(3): 169-174
DOI: 10.1055/s-0030-1267470
CASE REPORT

© Thieme Medical Publishers

Candida Infection in Total Knee Arthroplasty with Successful Reimplantation

Bradley Graw1 , Steven Woolson1 , James I. Huddleston1
  • 1Department of Orthopaedics, Stanford University, Redwood City, California
Further Information

Publication History

Publication Date:
27 October 2010 (online)

ABSTRACT

Fungal infections associated with prosthetic joints are uncommon. The first case report describes a woman with insidious onset of a candidal infection of a revision total knee arthroplasty. After multiple joint debridements and prolonged antibacterial and antifungal therapy, she had a successful reimplantation of a knee prosthesis. The second case report concerns a man who had a primary cemented total knee arthroplasty that became infected with Candida albicans. He underwent resection arthroplasty with eventual replant without recurrence at 20 years. Although resection arthroplasty should be maintained as the gold standard in the surgical treatment of this problem, the first case shows a successful short-term outcome of reimplantation of a patient with fungal infection of long-stemmed, revision total knee replacement. It also shows a treatment failure with fluconazole that was cured by voriconazole and caspofungin, two more recently developed antifungal agents.

REFERENCES

  • 1 Yang S H, Pao J L, Hang Y S. Staged reimplantation of total knee arthroplasty after Candida infection.  J Arthroplasty. 2001;  16 529-532
  • 2 Levine M, Rehm S J, Wilde A H. Infection with Candida albicans of a total knee arthroplasty. Case report and review of the literature.  Clin Orthop Relat Res. 1988;  226 235-239
  • 3 Lerch K, Kalteis T, Schubert T, Lehn N, Grifka J. Prosthetic joint infections with osteomyelitis due to Candida albicans.  Mycoses. 2003;  46 462-466
  • 4 Phelan D M, Osmon D R, Keating M R, Hanssen A D. Delayed reimplantation arthroplasty for candidal prosthetic joint infection: a report of 4 cases and review of the literature.  Clin Infect Dis. 2002;  34 930-938
  • 5 Azzam K, Parvizi J, Jungkind D et al.. Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience.  J Bone Joint Surg Am. 2009;  91 (S 06) 142-149
  • 6 Darouiche R O, Hamill R J, Musher D M, Young E J, Harris R L. Periprosthetic candidal infections following arthroplasty.  Rev Infect Dis. 1989;  11 89-96
  • 7 Austin K S, Testa N N, Luntz R K, Greene J B, Smiles S. Aspergillus infection of total knee arthroplasty presenting as a popliteal cyst. Case report and review of the literature.  J Arthroplasty. 1992;  7 311-314
  • 8 Gaston G, Ogden J. Candida glabrata periprosthetic infection: a case report and literature review.  J Arthroplasty. 2004;  19 927-930
  • 9 Mabry T M, Vessely M B, Schleck C D, Harmsen W S, Berry D J. Revision total knee arthroplasty with modular cemented stems: long-term follow-up.  J Arthroplasty. 2007;  22 (6) 100-105
  • 10 Bruce A S, Kerry R M, Norman P, Stockley I. Fluconazole-impregnated beads in the management of fungal infection of prosthetic joints.  J Bone Joint Surg Br. 2001;  83 183-184
  • 11 Ceffa R, Andreoni S, Borrè S et al.. Mucoraceae infections of antibiotic-loaded cement spacers in the treatment of bacterial infections caused by knee arthroplasty.  J Arthroplasty. 2002;  17 235-238
  • 12 Goss B, Lutton C, Weinrauch P, Jabur M, Gillett G, Crawford R. Elution and mechanical properties of antifungal bone cement.  J Arthroplasty. 2007;  22 902-908
  • 13 Pappas P G, Kauffman C A, Andes D Infectious Diseases Society of America et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.  Clin Infect Dis. 2009;  48 503-535

Bradley GrawM.D. 

Department of Orthopaedics

450 Broadway Street, Redwood City, CA 94063

Email: bradley.graw@gmail.com