title: Fungal peri-prosthetic joint infection after primary total knee replacement.
abstract: We retrospectively reviewed 30 two-stage revision procedures in 28 patients performed for fungal peri-prosthetic joint infection (PJI) after a primary total knee replacement. Patients were followed for at least two years or until the infection recurred. The mean follow-up for patients who remained free of infection was 4.3 years (2.3 to 6.1). Overall, 17 patients were assessed as American Society of Anesthesiologists grade 3 or 4. The surgical protocol included removal of the infected implant, vigorous debridement and insertion of an articulating cement spacer. This was followed by at least six weeks of antimicrobial treatment and delayed reimplantation in all patients. The mean interval between removal of the prosthesis and reimplantation was 9.5 weeks (6 to 24). After reimplantation, patients took antifungal agents orally for a maximum of six months. Two knees became reinfected at one and two months post-operatively, respectively: one of these subsequently required arthrodesis because of uncontrolled infection. Fungal PJIs can be treated successfully by removal of all infected material, appropriate antimicrobial treatment and delayed reimplantation.
authors.affiliation: Himchan Hospital, Joint & Arthritis Research, Department of Orthopaedic Surgery, 404-3 Mok-dong, Yangcheon-gu, Seoul 158-806, Korea.
authors.forename: B H
authors.initials: BH
authors.lastname: Hwang
authors.forename: J Y
authors.initials: JY
authors.lastname: Yoon
authors.forename: C H
authors.initials: CH
authors.lastname: Nam
authors.forename: K A
authors.initials: KA
authors.lastname: Jung
authors.forename: S C
authors.initials: SC
authors.lastname: Lee
authors.forename: C D
authors.initials: CD
authors.lastname: Han
authors.forename: S H
authors.initials: SH
authors.lastname: Moon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee; D003646:Debridement / Q000379:methods; D020878:Device Removal; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008875:Middle Aged; D009181:Mycoses / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents