Abstract
INTRODUCTION
Peri-prosthetic fungal infection is generally considered more difficult to cure than a bacterial infection. Two-stage exchange is considered the gold standard of surgical treatment. A recent study, however, reported a favorable outcome after one stage exchange in selected cases where the fungus was identified prior to surgery.
The routine one stage exchange policy for bacterial peri-prosthetic infection involves the risk of identifying a fungal infection mimicking bacterial infection solely on intraoperative samples, i.e. after reimplantation, realizing actually a one stage exchange for fungal infection without pre-operative identification of the responsible fungus, which is considered to have a poor prognosis. We report two such cases of prosthetic hip and knee fungal infection. Despite this negative characteristic, no recurrence of the fungal infection was observed.
CASE N°1: A 78 year old patient was referred for loosening of a chronically infected total hip arthroplasty (Staphylococcus aureus and Streptococcus dysgalactiae). One stage exchange was performed. Intraoperative bacterial cultures remained sterile. Two fungal cultures were positive for Candida albicans. Antifungal treatment was initiated for three months. No infection recurrence was observed at three year follow up.
CASE N° 2: A 53-year-old patient was referred for loosening of a chronically infected total knee prosthesis (Staphylococcus aureus methicillin susceptible, Klebsiella pneumoniae and Staphylococcus epidermidis). One stage exchange was performed. Intraoperative bacterial cultures remained sterile. Five fungal cultures were positive for Candida albicans. Antifungal treatment was initiated for three months. No infection recurrence was observed at two-year follow-up.
DISCUSSION
This experience suggests that eradication of fungal infection of a total hip or knee arthroplasty may be possible after one stage exchange even in cases where the diagnosis of fungal infection was not known before surgery, when the fungus was not identified and its antifungal susceptibility has not been evaluated before surgery. It is however not possible to propose this strategy as a routine procedure.
CONCLUSION
We suggest evaluating the results of one stage exchange for peri-prosthetic fungal infection on a larger scale.
