Introduction: Fungal periprosthetic joint infections (PJI) are exceptionally rare, accounting for <1% of all PJIs. Among them, Candida albicans is the most frequently implicated pathogen, yet its management remains highly challenging. Case Report: We report the case of an 85-year-old female who presented with a draining sinus at the right hip, 4 weeks after revision total hip arthroplasty (THA). Her surgical history included a prior failed revision due to recurrent dislocation. Clinical and laboratory findings suggested PJI. Intraoperative cultures and sonication confirmed multimicrobial and C. albicans infection. Following 4 months of antimicrobial therapy, she underwent debridement and removal of the acetabular component. Postoperatively, she received a 4-week course of trimethoprim–sulfamethoxazole (960 mg 3 times daily) and a 12-week course of fluconazole (200 mg twice daily). The post-operative course was uneventful. At 6 and 12-month follow-up, she remained asymptomatic with a well-healed wound and negative inflammatory markers. Conclusion: Early recognition and combined surgical–pharmacological management can lead to infection eradication and functional preservation, even in rare polymicrobial fungal PJIs. Keywords: Candida albicans, fungal periprosthetic joint infection, total hip arthroplasty, debridement and implant retention, fluconazole.

Background: The primary concern of hip surgeons is restoring the physiological biomechanics of the hip joint through arthroplasty, thereby enabling patients with osteoarthritis to engage better in daily activities. The modularity of the femoral stem-neck head allows surgeons to better restore the hip’s native biomechanics. However, concerns have been raised regarding the potential postoperative complications. This study aims to evaluate patients’ satisfaction and functional outcomes following primary Total Hip Arthroplasty (THA) with modular stem-neck, with a mean follow-up duration of eight years. Methods: We retrospectively reviewed 208 patients who underwent primary THA with modular stem-neck between February 2012 and July 2019. The follow-up period extended from November 2024 to April 2025. Patients who died from unrelated causes were excluded. Patients’ satisfaction was assessed using the SF-36 questionnaire, while functional outcomes were evaluated using the Harris Hip Score (HHS). Intraoperative and postoperative complications were meticulously documented. Results: The average follow-up duration was 95.6 months, with a range from 67.7 to 159.7 months. The mean SF-36 score was 91.2 out of 100, indicating high patient satisfaction. The mean HHS was 90 out of 100, reflecting excellent functional outcomes. Notably, some patients achieved the maximum score of 100 in both SF-36 and HHS assessments, while the lowest recorded scores were 54 and 50, respectively. The mean age of patients at the time of surgery was 67.1 years. One case of periprosthetic fracture was reported; however, no complications related to modular necks, such as trunnionosis or implant failure, were observed. Conclusions: The present study demonstrates that modular neck primary THA could achieve excellent functional and radiological outcomes, high patient satisfaction, and outstanding long-term survivorship, provided that implant selection and surgical technique follow biomechanical principles.