Reprise en deux temps d’infection péri prothétique fongique dans les suites d’une arthroplastie de genou de première intention

Fungal peri-prosthetic joint infections (PJI) are rare complications following total knee arthroplasty (TKA). There exist no established guidelines in the treatment of these infections and controversies are focused on the usefulness of antifungal-loaded cement spacers, the duration of systemic antifungal treatment and the ideal interval between implant removal and reimplantation. Therefore, we ask if: (1) adding antifungal in cement space is a viable solution to manage fungal PJI, (2) there is no adverse effect adding antifungal medication in cement? We hypothesized that fungal PJI following TKA could be managed successfully by two-stage reimplantation strategy using antifungal-loaded cement spacer. Five cases of fungal PJI following total knee arthroplasty were treated in our institution between 2007 and 2013 using a two-stage reimplantation strategy. The median elapsed time from primary arthroplasty to the diagnosis of infection was 7.4 months (range, 5–10 months). The infection was caused by Candida species in four cases and Pichia anomala in one case. Antibiotic- and antifungal-loaded articulating cement spacer was implanted during the interval between stages. Systemic antifungal agents were administered for at least 6 weeks after removal of prosthesis in all cases. The mean interval between removal and reimplantation was 6 months (range, 3–9 months). At a mean follow-up of 41.6 months (range, 24–65 months) after reimplantation, no patient had recurrent infection or revision due to any other reasons. The mean global IKS score improved from 58.4 (range, 37–96 points) preoperatively to 152.4 (range, 136–169 points) at final follow-up. The average range of motion of the knee for flexion improved from 63° (range, 10–110°) preoperatively to 98° (range, 80–120°) at final follow-up. Fungal PJI following TKA can be successfully treated by a staged reimplantation strategy. Antibiotic- and antifungal-loaded cement spacer implanted during interval period between stages may be an effective adjunct to therapy. Effective antifungal therapy is crucial to a successful result without adverse effect. IV: retrospective or historical series.