Delayed Reimplantation Arthroplasty for Candidal Prosthetic Joint Infection: A Report of 4 Cases and Review of the Literature

David M. Phelan 1 2 Douglas R. Osmon () 1 2 Michael R. Keating 1 2 Arlen D. Hanssen 0 1 0 Department of Orthopedic Surgery, Mayo Clinic and Foundation , Rochester, Minnesota 1 Received 13 July 2001; revised 8 November 2001; electronically published 26 February 2002. 5-528 Marian Hall, Mayo Clinic Rochester , 200 First St. SW, Rochester, MN 55905 2 Division of Infectious Diseases, Department of Internal Medicine Fungal prosthetic joint infection (PJI) is rare, with Candida species being the most frequently reported pathogen in the medical literature. The risk of relapse following delayed reimplantation arthroplasty for candidal PJI is unknown. We describe 4 new cases and summarize 6 previously reported cases of candidal PJI treated with delayed reimplantation arthroplasty. Ninety percent of the patients received antifungal therapy. Eight patients received amphotericin B either alone or in combination with other antifungals. One patient received fluconazole alone. The median duration of time from resection arthroplasty to reimplantation for total hip and total knee arthroplasties was 8.6 and 2.3 months, respectively. Eight patients did not have relapse of candidal PJI following delayed reimplantation arthroplasty after a median duration of follow-up of 50.7 months (range, 2-73 months). Candidal PJI can be successfully treated with delayed reimplantation arthroplasty after receipt appropriate antifungal therapy. - Characteristic No. male patients/no. female patients Age, years Joint location, no. THA/no. TKA Prosthetic joint age, months Time from implantation to onset of symptoms, months Duration of symptoms, months Mayo Clinic (n p 4) 2/2 73.9 (60.883.2) 3/1 26.8 (14.9184.2) Patient group Literature (n p 6) 22.1 (10.1179.6) 4.7 (4.35.1) All RESULTS DISCUSSION Therapy Monotherapy Fluconazole Mayo Clinic (n p 4) Patient group Literature (n p 6) 750 (5001000) 200 (25400) 1195 (8212100) 200 1000 (5002100) 200 (25400) 53.5 (3671) 61 (47269) 42.0 (32.042.0) 182.5a 42 (4271) 122 (47269) References (...truncated)