Candidal arthritis in revision knee arthroplasty successfully treated with sequential parenteral-oral fluconazole and amphotericin B-loaded cement spacer


We present a case of a patient with preoperative cutaneous candidiasis, who developed candidal infection during stage revision knee arthroplasty. The patient received intravenous fluconazole for 6 weeks and resection arthroplasty with an amphotericin B-loaded cement spacer and continuous oral fluconazole therapy for 9 weeks. Revision surgery was successful.

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  1. 1.

    Azzam K, Parvizi J, Jungkind D, Hanssen A, Fehring T, Springer B, Bozic K, Della Valle C, Pulido L, Barrack R (2009) Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg Am 91(Suppl 6):142–149

    Article  PubMed  Google Scholar 

  2. 2.

    Barson WJ, Marcon MJ (1996) Successful therapy of Candida albicans arthritis with a sequential intravenous amphotericin B and oral fluconazole regimen. Pediatr Infect Dis J 15:1119–1122

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Cushing RD, Fulgenzi WR (1997) Synovial fluid levels of fluconazole in a patient with Candida parapsilosis prosthetic joint infection who had an excellent clinical response. Arthroplasty 12:950

    CAS  Article  Google Scholar 

  4. 4.

    Darouiche RO, Hamill RJ, Musher DM, Young EJ, Harris RL (1989) Periprosthetic candidal infections following arthroplasty. Rev Infect Dis 11:89–96

    CAS  PubMed  Google Scholar 

  5. 5.

    Fisher MA, Shen SH, Haddad J, Tarry WF (1989) Comparison of in vivo activity of fluconazole with that of amphotericin B against Candida tropicalis, Candida glabrata, and Candida krusei. Antimicrob Agents Chemother 33:1443–1446

    CAS  PubMed  Google Scholar 

  6. 6.

    Gaston G, Ogden J (2004) Candida glabrata periprosthetic infection: a case report and literature review. Arthroplasty 19:927–930

    Article  Google Scholar 

  7. 7.

    Goodman JS, Seibert DG, Reahl GE Jr, Geckler RW (1983) Fungal infection of prosthetic joints: a report of two cases. J Rheumatol 10:494–495

    CAS  PubMed  Google Scholar 

  8. 8.

    Goss B, Lutton C, Weinrauch P, Jabur M, Gillett G, Crawford R (2007) Elution and mechanical properties of antifungal bone cement. J Arthroplasty 22:902–908

    Article  PubMed  Google Scholar 

  9. 9.

    Hay RJ (1996) Yeast infections. Dermatol Clin 14:113–124

    CAS  PubMed  Google Scholar 

  10. 10.

    Kohli R, Hadley S (2005) Fungal arthritis and osteomyelitis. Infect Dis Clin North Am 19:831–851

    Article  PubMed  Google Scholar 

  11. 11.

    Levine M, Rehm SJ, Wilde AH (1988) Infection with Candida albicans of a total knee arthroplasty. Case report and review of the literature. Clin Orthop Relat Res 226:235–239

    PubMed  Google Scholar 

  12. 12.

    Marra F, Robbins GM, Masri BA, Duncan C, Wasan KM, Kwong EH, Jewesson PJ (2001) Amphotericin B-loaded bone cement to treat osteomyelitis caused by Candida albicans. Can J Surg 44:383–386

    CAS  PubMed  Google Scholar 

  13. 13.

    Raczyńska-Witońska G, Witoński D (2006) Fungi and bacteria as a pathogenic factor in wound healing in patients after orthopaedic surgeries. Ortop Traumatol Rehabil 8:646–649

    PubMed  Google Scholar 

  14. 14.

    Tunkel AR, Thomas CY, Wispelwey B (1993) Candida prosthetic arthritis: report of a case treated with fluconazole and review of the literature. Am J Med 94:100–103

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Wada M, Baba H, Imura S (1998) Prosthetic knee Candida parapsilosis infection. Arthroplasty 13:479–482

    CAS  Article  Google Scholar 

  16. 16.

    Wyman J, McGough R, Limbird R (2002) Fungal infection of a total knee prosthesis: successful treatment using articulating cement spacers and staged reimplantation. Orthopedics 25:1391–1394

    PubMed  Google Scholar 

  17. 17.

    Yang SH, Pao JL, Hang YS (2001) Staged reimplantation of total knee arthroplasty after Candida infection. Arthroplasty 16:529–532

    CAS  Article  Google Scholar 

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Correspondence to Kuo-Yao Hsu.

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Wu, MH., Hsu, KY. Candidal arthritis in revision knee arthroplasty successfully treated with sequential parenteral-oral fluconazole and amphotericin B-loaded cement spacer. Knee Surg Sports Traumatol Arthrosc 19, 273–276 (2011).

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  • Candida albicans
  • Fungal prosthetic infection
  • Fluconazole
  • Amphotericin B