Fungal Prosthetic Joint Infection by Candida parapsilosis After Total Knee Arthroplasty

Abstract

Total knee arthroplasty is an increasingly common surgical intervention for degenerative knee disease, yet it carries a risk of prosthetic joint infection (PJI). While bacterial infections dominate the landscape of PJIs, fungal infections represent a rare but significant concern, especially in immunocompromised patients. This case report describes a 71-year-old patient who presented in October 2024 with left knee pain and swelling 7 months after total knee arthroplasty. A prosthetic joint infection due to Candida parapsilosis was diagnosed preoperatively by repetitive microbiological examination of synovial fluid and intraoperatively by tissue samples and sonication of prosthetic material. A two-stage revision surgery with a short 4-week interval was performed using an antifungal-impregnated spacer, followed by 6 months of systemic antifungal treatment with fluconazole and continued by fluconazole suppressive treatment for another 6 months. A favorable clinical and functional outcome was achieved after 11 months of follow-up. This is a rare case of fungal PJI treatment with a two-stage revision with a shorter interval, using an antifungal impregnated spacer combined with a prolonged antifungal therapy.

Keywords: Candida parapsilosis; antifungal spacer; case report; fungal prosthetic joint infection; total knee arthroplasty.

Figure 1

Radiology of left knee—anteroposterior and lateral views of the knee before implantation of total knee endoprosthesis, showing severe knee osteoarthrosis with heterotopic ossifications after quadriceps rupture and surgical treatment years ago.

Figure 2

Contrast-enhanced magnetic resonance image of left knee: axial and lateral view of the left knee showing pronounced synovitis intra-articular with a small effusion, extending through the defect of the quadriceps tendon just above the patella into the subcutaneous tissue suprapatellar, forming a large septate collection, small osteolysis around the femoral part of knee endoprosthesis.

Figure 3

Preparation of antifungal-impregnated spacer.

Figure 4

Radiography of the left knee—anteroposterior and lateral views of the knee after removal of knee endoprosthesis and insertion of an antibiotic- and antifungal-impregnated cemented spacer.

Figure 5

Radiography of the left knee—anteroposterior and lateral views after reimplantation of revision knee endoprosthesis.