Prosthetic joint infections due to Mycobacterium tuberculosis: A retrospective study

• Published in: Joint, bone, spine : revue du rhumatisme Vol. 86; no. 2; pp. 239 - 243
• Main Authors: Meyssonnier, Vanina, Zeller, Valérie, Malbos, Stéphanie, Heym, Beate, Lhotellier, Luc, Desplaces, Nicole, Marmor, Simon, Ziza, Jean-Marc
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.03.2019
• Subjects: Aged; Antitubercular Agents - administration & dosage; Device Removal - methods; Female; Follow-Up Studies; France; Hip Prosthesis - adverse effects; Hospitals, University; Humans; Incidence; Male; Middle Aged; Mycobacterium tuberculosis; Mycobacterium tuberculosis - isolation & purification; Periprosthetic joint infection; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - therapy; Reoperation - statistics & numerical data; Retrospective Studies; Risk Assessment; Sampling Studies; Treatment Outcome; Tuberculosis, Osteoarticular - diagnosis; Tuberculosis, Osteoarticular - therapy; France; Mycobacterium tuberculosis; Periprosthetic joint infection
• ISSN: 1297-319X; 1778-7254
• DOI: 10.1016/j.jbspin.2018.09.008

•Tuberculous prosthetic joint infection is rare. The diagnosis is simple but requires culturing of osteoarticular samples on a medium specifically designed to detect mycobacteria.•The prognosis is good in patients given appropriate anti-tuberculosis therapy, whose optimal duration remains to be defined.•The surgical strategy should be discussed on a case-by-case basis. Surgery is not always required when the diagnosis is made based on samples taken during implantation of the prosthesis. Tuberculous prosthetic joint infection (PJI) is uncommon and often diagnosed late. The objective here is to describe the management of tuberculous PJI at an osteoarticular infection referral center. A single-center retrospective study of patients managed between 1987 and 2016 was performed. We identified 9 patients with a median age of 80 years. The hip was involved in all 9 patients. A known history of tuberculosis was noted in 2 patients and tuberculosis was present at other sites in 4 patients (lung, n = 3; urinary tract and scrotum, n = 1; and spine, n = 1). The diagnosis was established by routine intra-operative microbiological sampling, during (n = 4) or at a distance from (n = 5) hip arthroplasty. In the 8 patients with available follow-up data, mean antibiotic therapy duration was 16 months (range, 12–18 months). None of the 4 patients in whom the infection was diagnosed during arthroplasty required surgical revision because of the infection. Of the other 5 patients, 3 were managed by exchange arthroplasty and 1 by excision of the hip without subsequent prosthesis implantation; the remaining patient did not undergo revision surgery. The infection was eradicated in all 9 patients, after 15 months to 10 years. Tuberculous PJI is uncommon. The prognosis is good with prolonged antibiotic therapy, although the optimal duration remains unclear. The surgical strategy should be discussed on a case-by-case basis. The prosthesis can be retained if the tuberculous infection is an unexpected finding during arthroplasty.