title: Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review.
abstract: Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.
authors: Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany.
authors: Oliver
authors: O
authors: Jakobs
authors: Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany.
authors: Benjamin
authors: B
authors: Schoof
authors: Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.
authors: Till Orla
authors: TO
authors: Klatte
authors: Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany.
authors: Stefan
authors: S
authors: Schmidl
authors: Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.
authors: Florian
authors: F
authors: Fensky
authors: Department of Trauma, Hannover Medical School , Hamburg, Germany.
authors: Daniel
authors: D
authors: Guenther
authors: Institute for Clinical Microbiology, Infectiology and Infection Control, Helios Endo-Klinik Hamburg , Hamburg, Germany.
authors: Lars
authors: L
authors: Frommelt
authors: Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany.
authors: Thorsten
authors: T
authors: Gehrke
authors: Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany ; Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.
authors: Matthias
authors: M
authors: Gebauer
keywords: fungal; periprosthetic joint infection; total knee arthroplasty