Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5401-5408
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5401
Candidal periprosthetic joint infection after primary total knee arthroplasty combined with ipsilateral intertrochanteric fracture: A case report
Jun Xin, Qing-Shan Guo, Hua-Yu Zhang, Zhi-Yang Zhang, Tomer Talmy, Yu-Zhuo Han, Yu Xie, Qiu Zhong, Si-Ru Zhou, Yang Li
Jun Xin, Qing-Shan Guo, Hua-Yu Zhang, Zhi-Yang Zhang, Yu-Zhuo Han, Yu Xie, Si-Ru Zhou, Yang Li, Department of Trauma Surgery, State Key Laboratory of Trauma, Burns and Combined Injuries, Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University of PLA, Chongqing 400042, China
Tomer Talmy, The Institute of Research in Military Medicine, The Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem 91120, Israel
Qiu Zhong, Department of Clinical Laboratory, Daping Hospital, Army Medical University of PLA, Chongqing 400042, China
Author contributions: Xin J and Guo QS wrote the first draft of the paper and contributed equally to this paper; Guo QS, Li Y performed the surgeries; Zhong Q contributed to the microbiological investigation; Talmy T and Zhang HY contributed to revision of the manuscript, literature review and discussion; Xie Y, Zhang ZY and Zhou SR collected the patient’s radiographic data; Li Y designed the case report and revised the discussion; the final version was approved by all authors.
Supported by Clinical Technology Innovation Cultivation Program of Army Medical University of PLA, No. CX2019JS109; Independent Project of State Key Laboratory of Trauma, Burns and Combined Injuries, No. SKLZZ201603; and Chongqing Appropriate Technology Promotion Project No. 2018jstg019.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016)
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yang Li, MD, PhD, Associate Professor, Surgeon, Department of Trauma Surgery, State Key Laboratory of Trauma, Burns and Combined Injuries, Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing 400042, China. dpliyang@tmmu.edu.cn
Received: February 25, 2020
Peer-review started: February 25, 2020
First decision: July 4, 2020
Revised: July 14, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: November 6, 2020
Processing time: 255 Days and 0.5 Hours
Abstract
BACKGROUND

Candidal periprosthetic joint infection is a rare and difficult to diagnose complication of total knee arthroplasty. The treatment of such complications is inconclusive and may include prosthesis removal, debridement, arthrodesis, and extensive antifungal therapy to control the infection.

CASE SUMMARY

A 62-year-old male with a history of total knee arthroplasty (TKA) in his left knee presented with ipsilateral knee pain and a sinus discharge 20 mo after TKA. The patient was previously evaluated for left knee pain, swelling, and a transient fever one month postoperatively. Prothesis removal and insertion of a cement spacer were performed in a local hospital six months prior to the current presentation. Medical therapy included rifampicin and amphotericin which were administered for 4 wk following prosthesis removal. A second debridement was performed in our hospital and Candida parapsilosis was detected in the knee joint. Fourteen weeks following the latter debridement, the patient suffered a left intertrochanteric fracture and received closed reduction and internal fixation with proximal femoral nail anterotation. Two weeks after fracture surgery, a knee arthrodesis with autograft was performed using a double-plate fixation. The patient recovered adequately and was subsequently discharged. At the two-year follow-up, the patient has a stable gait with a pain-free, fused knee.

CONCLUSION

Fungal periprosthetic joint infection following TKA may be successfully and safely treated with prosthesis removal, exhaustive debridement, and arthrodesis after effective antifungal therapy. Ipsilateral intertrochanteric fractures of the affected knee can be safely fixated with internal fixation if the existing infection is clinically excluded and aided by the investigation of serum inflammatory markers.

Keywords: Infection; Periprosthetic joint infection; Intertrochanteric fracture; Fungal; Arthrodesis; Case report

Core Tip: We report a unique case of fungal periprosthetic joint infection further complicated by ipsilateral intertrochanteric fracture following total knee arthroplasty. We demonstrate that therapy including prosthesis removal, exhaustive debridement, and arthrodesis after effective antifungal therapy may be adequate for controlling such infections. Additionally, internal fixation of ipsilateral intertrochanteric fractures following such infections may be safe if clinical and laboratory investigations suggest resolution of the former infection.