Fungal periprosthetic joint infection after total knee arthroplasty.

Total knee replacement is an effective procedure for severely diseased knee joints; however one of the major problems resulting in failure of arthroplasty is periprosthetic joint infection. Fungal infection is rarely found perprosthetic joints infection, but the incidence may be increased in high riskpatients. Progression of the disease and definitive treatment guidelines have not yet been established. In two cases of fungal periprosthetic joint infection the organism was identified from cultures as Candida spp. Those patients had developed symptoms of pain and local knee inflammation six years after total knee replacement. A two-stage operation was carried out. The first operation removed the prosthesis, the polyethylene surface, the cement mantle and the infected tissue. After identification of the organism, the correct antibiotic was administered until the infection was controlled. A second operation was carried out to re-implant the prosthesis after the infection had subsided. A summary of reports in the literature regarding treatment of fungal periprosthetic infections as well as an algorithm for treatment decision making are presented.