Fungal Periprosthetic Joint Infection in Total Knee Arthroplasty - Case Report

Abstract

Introduction: Fungal prosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty. We are reporting a case of prosthetic joint infection caused an emerging resistant yeast pathogen.–Candida auris which was successfully treated by a staged revision TKR and antifungal bead insertion and had a good clinical outcome. Resection arthroplasty with delayed re-implantation (two-stage revision) combined with specific culture directed antifungal therapy and supportive care can be used to successfully treat such serious infections. Aim of Article: Our aim is to ascertain the importance of looking for a fungal source of on infection in all failed knee replacement so that effective treatment can be started early. Case: 70 yr old male presented with pain and swelling left knee for 1 year. TKR was done in a staged manner left first followed by right. He underwent Two-stage revision TKR. On evaluation he was diagnosed to have infection of left knee prosthesis and was planned on Revision TKR (Staged). Although he improved clinically, he had reactivation of infection and ended up in arthrodesis of knee joint. Conclusion: Two-stage revision TKR with appropriate antimicrobial treatment can give good results in patients with a fungal PJI. Fungal etiology should be considered in patients with negative cultures or if host immunity is compromised. The present case also highlights the need for more studies and evidence-based recommendations in the management of fungal PJI especially with respect to dosing and duration of therapy.