Fungal Periprosthetic Infection after Total Knee Arthroplasty (Case Report and Review)

Cover Page

Cite item


The rate of periprosthetic infection (PJI) following primary total knee arthroplasty ranges from 0,5 to 6%, while after the revision arthroplasty PJI rate grows up to 13,6%. Despite the fact that PJI is more often caused by gram-positive microorganisms, the treatment of patients induced by gram-negative pathogens and fungi is the most complex and associated with the higher recurrence rate. This paper presents a positive two-stage treatment of a patient with fungal periprosthetic infection with a review of current medical literature. Revision, sanation of infection site and implantation of articulating antibacterial spacer was performed in the first stage of treatment. The second stage, which was the implantation of a revision prosthesis, followed in 6 months after removal of infection nidus. Subsequently the authors obtained good functional outcomes and stopping the infection process.

About the authors

S. A. Bozhkova

Vreden Russian Research Institute of Traumatology and Orthopedics

Svetlana A. Bozhkova — Dr. Sci. (Med.), Head of the Research Department of Prevention and Treatment of Wound Infection and Department of Clinical Pharmacology Russian Federation

P. P. Ivanov

Vreden Russian Research Institute of Traumatology and Orthopedics

Pavel P. Ivanov — Orthopedic Surgeon Russian Federation

E. A. Zemlyanskaya

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Elizaveta A. Zemlyanskaya — Orthopedic Surgeon Russian Federation

N. N. Kornilov

Vreden Russian Research Institute of Traumatology and Orthopedics;
Mechnikov North-Western State Medical University


Nikolai N. Kornilov — Dr. Sci. (Med.), Professor, Chair of Traumatology and Orthopedics; Head of Trauma and Orthopedic Department

Professor, Chair of Traumatology and Orthopedics

Russian Federation


  1. Божкова С.А. Современные принципы диагностики и антибактериальной терапии инфекции протезированных суставов (обзор литературы). Травматология и ортопедия России. 2011;(3):126-136. doi: 10.21823/2311-2905-2011-0-3-126-136.
  2. Пичхадзе И.М., Кузьменков К.А., Жадин А.В., Цискарашвили А.В., Пичхадзе Е.И., Данелия Л.М., и др. Лечение больных с гнойно-воспалительными осложнениями после эндопротезирования тазобедренного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2009;(3):45-50.
  3. Aggarwal V.K., Bakhshi H., Ecker N.U., Parvizi J., Gehrke T., Kendoff D. Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg. 2014;27(5):399-406. doi: 10.1055/s-0033-1364102.
  4. Phillips C.B., Barrett J.A., Losina E., Mahomed N.N., Lingard E.A., Guadagnoli E. et al. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am. 2003;85(1):20-26. doi: 10.2106/00004623-200301000-00004.
  5. Корнилов Н.Н., Куляба Т.А., Филь А.С., Муравьёва Ю.В. Данные регистра эндопротезирования коленного сустава РНИИТО им. Р.Р. Вредена за 2011-2013 годы. Травматология и ортопедия России. 2015;(1):136-151. doi: 10.21823/2311-2905-2015-0-1-136-151.
  6. Преображенский П.М., Божкова С.А., Каземирский А.В., Гончаров М.Ю. Результаты этапного лечения пациентов с перипротезной инфекцией после эндопротезирования коленного сустава. Травматология и ортопедия России. 2017;23(1):98-107. doi: 10.21823/2311-2905-2017-23-1-98-107.
  7. Koh I.J., Cho W.S., Choi N.Y., Kim T.K. Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study. Clin Orthop Relat Res. 2014;472(1):316-326. doi: 10.1007/s11999-013-3252-8.
  8. Aboltins C., Daffy J., Choong P., Stanley P. Current concepts in the management of prosthetic joint infection. Intern Med J. 2014;44(9):834-840. doi: 10.1111/imj.12510.
  9. Carrega G., Cavagnaro L., Basso M., Riccio G., Ronca A., Salomone C., Burastero G. Azole-resistant Candida albicans prosthetic joint infection treated with prolonged administration of anidulafungin and two-stage exchange with implant of a megaprosthesis. J Chemother. 2017;29(6):386-388. doi: 10.1080/1120009X.2016.1199409.
  10. Castelli C.C., Gotti V., Ferrari R. Two-stage treatment of infected total knee arthroplasty: two to thirteen year experience using an articulating preformed spacer. Int Orthop. 2014;38(2):405-412. doi: 10.1007/s00264-013-2241-6.
  11. Goldman R.T., Scuderi G.R., Insall J.N. 2-stage reimplantation for infected total knee replacement. Сlin Orthop Relat Res. 1996;(331):118-124. doi: 10.1097/00003086-199610000-00016.
  12. Kuiper J.W., van den Bekerom M.P, van der Stappen J., Nolte P.A., Colen S. 2-stage revision recommended for treatment of fungal hip and knee prosthetic joint infections. Acta Orthop. 2013;84(6):517-523. doi: 10.3109/17453674.2013.859422.
  13. Schoof B., Jakobs O., Schmidl S., Klatte T.O., Frommelt L., Gehrke T., Gebauer M. Fungal periprosthetic joint infection of the hip: a systematic review. Orthop Rev (Pavia). 2015;7(1):5748. doi: 10.4081/or.2015.5748.
  14. Açikgöz Z.C., Sayli U., Avci S., Doğruel H., Gamberzade S. An extremely uncommon infection: Candida glabrata arthritis after total knee arthroplasty. Scand J Infect Dis. 2002;34(5):394-396. doi: 10.1080/00365540110080232.
  15. Dubost J.J.1, Soubrier M., De Champs C., Ristori J.M., Bussiére J.L., Sauvezie B. No changes in the distribution of organisms responsible for septic arthritis over a 20-year period. Ann Rheum Dis. 2002;61(3):267-269. doi: 10.1136/ard.61.3.267.
  16. Goldman R.T., Scuderi G.R., Insall J.N. 2-stage reimplantation for infected total knee replacement. Сlin Orthop Relat Res. 1996;(331):118-124. doi: 10.1097/00003086-199610000-00016.
  17. Lackner M., De Man F.H., Eygendaal D., Wintermans R.G., Kluytmans J.A., Klaassen C.H., Meis J.F. Severe prosthetic joint infection in an immunocompetent male patient due to a therapy refractory Pseudallescheria apiosperma. Mycoses. 201;54 Suppl 3:22-27. doi: 10.1111/j.1439-0507.2011.02107.x.
  18. Marculescu C.E., Berbari E.F., Cockerill F.R. 3rd, Osmon D.R. Fungi, mycobacteria, zoonotic and other organisms in prosthetic joint infection. Clin Orthop Relat Res. 2006;451:64-72. doi: 10.1097/01.blo.0000229337.21653.f2
  19. Bracken C.D., Berbari E.F., Hanssen A.D., Mabry T.M., Osmon D.R., Sierra R.J. Systemic inflammatory markers and aspiration cell count may not differentiate bacterial from fungal prosthetic infections. Clin Orthop Relat Res. 2014;472(11):3291-3294. doi: 10.1007/s11999-014-3631-9.
  20. Сobo F., Rodríguez-Granger J., Sampedro A., AliagaMartínez L., J. Navarro-Marí. Candida Prosthetic Joint Infection. A Review of Treatment Methods. J Bone Jt Infect. 2017;2(2): 14-121. doi: 10.7150/jbji.17699.
  21. Botha L., le Roux T.L.B., McLoughlin H. Periptosthetic fungal infections: be alert (clinical cases and review of the literature). SA Orthop J. 2016;15(2):14-21. doi: 10.17159/2309-8309/2016/v15n2a1.
  22. Dutronc H., Dauchy F.A., Cazanave C., Rougie C., Lafarie-Castet S., Couprie B. et al. Candida prosthetic infections: case series and literature review. Scand J Infect Dis. 2010;42(11-12):890-895. doi: 10.3109/00365548.2010.498023.
  23. Goff T.A.J., Rambani R., NG. A.B. Current concepts in the management of periprosthetic fungal joint infection using antifungal bone cement. Current Orthopaedic Practice. 2014; 25(2):169-174. doi: 10.1097/bco.0000000000000074.
  24. Geng L., Xu M., Yu L., Li J., Zhou Y., Wang Y., Chen J. Risk factors and the clinical and surgical features of fungal prosthetic joint infections: A retrospective analysis of eight cases. Exp Ther Med. 2016;12(2): 991-999. doi: 10.3892/etm.2016.3353.
  25. Hwang B.H., Yoon J.Y., Nam C.H., Jung K.A., Lee S.C., Han C.D., Moon S.H. Fungal peri-prosthetic joint infection after primary total knee replacement. J Bone Joint Surg Br. 2012;94(5):656-659.
  26. Wang Q.J., Shen H., Zhang X.L., Jiang Y., Wang Q., Chen Y.S., Shao J.J. Staged reimplantation for the treatment of fungal peri-prosthetic joint infection following primary total knee arthroplasty. Orthop Traumatol Surg Res. 2015;101(2):151-156. doi: 10.1016/j.otsr.2014.11.014. Epub 2015 Feb 9.
  27. Wiwattanawarang N. Fungal periprosthetic joint infection after total knee arthroplasty. J Med Assoc Thai. 2014;97(12):1358-1363.

Copyright (c)

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies