Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5401
Peer-review started: February 25, 2020
First decision: July 4, 2020
Revised: July 14, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: November 6, 2020
Processing time: 255 Days and 0.5 Hours
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.
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.
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.
Core Tip: We report a unique case of fungal periprosthetic joint infection further complicated by ipsilateral intertrochanteric fracture following total knee arthroplasty. We demonstrate that therapy including prosthesis removal, exhaustive debridement, and arthrodesis after effective antifungal therapy may be adequate for controlling such infections. Additionally, internal fixation of ipsilateral intertrochanteric fractures following such infections may be safe if clinical and laboratory investigations suggest resolution of the former infection.