Recalcitrant Fungal Prosthetic Joint Infection of the Knee Cleared Using Voriconazole via Intra‐Articular Catheters

Prosthetic joint infection (PJI) is a high‐cost and high‐morbidity complication of total joint arthroplasty accounting for about 1%–2% of all joint replacements. Rarely, a fungal pathogen may cause coinfection or superinfection and complicate treatment. Fungal PJI is associated with higher morbidity and a lower rate of clearance of infection, with rates as low as 50% or less in the literature. Intra‐articular antibiotics as a treatment for PJI may be a promising intervention for challenging PJIs. We present a novel case utilizing voriconazole via intra‐articular catheters with successful clearance of a recalcitrant fungal prosthetic joint infection with 2 years' follow‐up. A detailed case study and protocol is presented for a 71‐year‐old male patient who failed two 2‐stage revision arthroplasties for complicated and recalcitrant fungal PJI. The patient was indicated for intra‐articular administration of antifungal medication. A two‐stage, both‐component knee revision with placement of two indwelling intra‐articular catheters was performed. Subsequently, voriconazole was administered daily for 6 weeks in alternating catheters. After completion of antifungal treatment, the catheters were removed in clinic. The patient demonstrates no evidence of infection after 2 years with a return to baseline function. To our knowledge, this is the first case in which intra‐articular voriconazole is administered through indwelling catheters of the knee. We demonstrate successful clearance of a complex and recalcitrant fungal PJI using this novel treatment. Intra‐articular use of voriconazole may be an option for patients with fungal PJI.