Candida albicans infection of a prosthetic knee replacement: a report and review of the literature

A woman with rheumatoid arthritis who underwent total knee arthroplasty is described. The implant became infected with Staphylococcus epidermidis and she received a prolonged course of postoperative antistaphylococcal antibiotics. Four months postoperatively she developed a calf ulcer that grew Pseudomonas aeruginosa and required further antibiotic therapy. One year later she presented with a painful, swollen knee with radiographic findings suggesting loosening of the prosthetic knee implant. Arthrocentesis cultures grew Candida albicans. She was treated with arthrodesis, amphotericin B, 5-fluorocytosine, and ketoconazole and remains free of infection 21 months after removal of the prosthesis. The clinical course of 6 other cases of Candida prosthetic joint infections is reviewed.