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Candida periprosthetic infection of the knee: a systematic review of surgical treatments and clinical outcomes

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A Correction to this article was published on 11 March 2022

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Abstract

Background

Candida periprosthetic joint infections (PJIs) are a rare cause of prosthesis revision with severe consequences and challenging treatment. This study aims to produce a systematic analysis of types of treatment and outcome of knee Candida PJIs and their correlation with specific pathogen species.

Methods

During April 2021, a literature search was performed according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guideline. Reviewers used the Oxford Level of Evidence (LoE) and Methodological index for non-randomized studies (MINORS) score. Modal value of surgical, pharmacological treatment and outcome along with the correlation between types of treatment and outcome was calculated through Chi-square or Fisher exact test.

Results

In total, 115 cases were collected through 51 articles, identifying 116 pathogens. Candida albicans was the most frequent pathogen. Analysis of LoE reveals 40 LoE 5 and 11 LoE 4. Thirteen patients underwent one-stage revision, 46 patients two-stage revision, 6 patients resection arthroplasty and arthrodesis, 4 patients long-term antifungal therapy, and 3 patients debridement with prosthesis retention. Global rate of success was 85.14%. Modal distribution revealed a preference for two-stage revision and Fluconazole in medical therapy. No difference in terms of fungal eradication was found among Candida species (p = 0.503) and for treatments except for two-stage revision and resection arthroplasty (p  = 0.0125) or debridement with implant retention (p  = 0.0498), and the rest of procedures and resection arthroplasty (0.0192). MINORS score was poor.

Conclusions

Analysis of the literature did not highlight any difference between types of surgical treatment and pathogens in terms of relapse or infection eradication. However, two-stage replacement may be preferred, allowing healing of infection in most cases.

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  1. Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, strada S. Rocchetto 99, 12084, Mondovì, Cuneo, Italy

    Federico Fusini

  2. Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy

    Gabriele Colò

  3. Department of Orthopaedic and Traumatology, Infermi Hospital of Rivoli, ASL TO3, Via Rivalta, 29, 10098, Rivoli, Turin, Italy

    Alessandro Rava

  4. Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, via Zuretti 29, Turin, Italy

    Luigi Sabatini, Alessandro Massè, Alessandro Aprato & Stefano Artiaco

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Contributions

FF and SA contributed to the study conception and design. FF, AR, AM, AA, and LS performed literature search; FF, SA, and GC performed the data analysis. FF the first draft of the manuscript was written; LS, SA, GC, and AM revised and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Fusini, F., Colò, G., Rava, A. et al. Candida periprosthetic infection of the knee: a systematic review of surgical treatments and clinical outcomes. Eur J Orthop Surg Traumatol 33, 899–907 (2023). https://doi.org/10.1007/s00590-022-03224-z

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