Total knee prosthesis infected with<i>Mycobacterium tuberculosis</i>

Elzein, Fatehi; Haris, Mohammed; Alolayan, Saad S; Sherbini, Nisreen Al

doi:10.1136/bcr-2017-220596

Cited by 7 publications

(5 citation statements)

References 8 publications

(7 reference statements)

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“…The initial database queries produced 191 reports; 162 articles were excluded, including those that were duplicates (43), reviews or meta‐analyses (24), descriptions of general periprosthetic joint infections (25), descriptions of hip replacements (14), descriptions of non‐tuberculous mycobacterium infections (all case reports, 14), articles on knee joint tuberculosis replacements (23), and non‐English reports (19) 13–41 . We identified 44 cases of TBPJI described in the 29 selected articles.…”

Section: Methodsmentioning

confidence: 99%

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

Wei

Sun²,

Zhang

et al. 2020

Orthopaedic Surgery

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Objectives: To provide a case series and systematic review that explores the clinical manifestations, treatments, and methods for defining tuberculosis diagnoses in patients who have undergone total knee arthroplasty (TKA). Methods: Four patients (three women, one man; average age, 59.5 ± 8.89 years; range, 48-69 years) underwent TKA and were subsequently treated for previously unsuspected knee tuberculosis between January 2013 and December 2019. We also reviewed published cases of tuberculous periprosthetic joint infections (TBPJIs) following TKA through databases of MEDLINE/PubMed, the Cochrane Library, and EMBASE. We reviewed studies that were published between January 1980 and December 2019. Results: In our four cases, the preoperative diagnoses were osteoarthritis (n = 2), rheumatoid arthritis (one case), and Charcot's arthropathy (one case). The main clinical manifestations were knee swelling and pain, without fever, weakness, or weight loss. Comorbidities included multiple joints with rheumatoid arthritis or Charcot's arthropathy, diabetes mellitus, and uremia. One patient had a history of lumbar tuberculosis treated with debridement and intervertebral fusion. Preoperative elevated erythrocyte sedimentation rates (ESRs) were detected in all cases, and elevated C-reactive protein (CRP) levels were observed in three cases. The tuberculosis diagnoses were confirmed via histopathologic analysis (three cases) and second-generation sequencing (one case). Three patients received antituberculosis therapy for 1 year, without surgical intervention. Two-stage exchange arthroplasty was performed in one patient because of prosthesis loosening. Within an average follow-up period of 24.75 months, tuberculosis reactivation was not observed and overall functional improvement was demonstrated. Forty-four TBPJI cases were reported in the literature between January 1980 and December 2019. Most (59.09%) occurred within the first year after the index arthroplasty, and the diagnoses were confirmed by culturing Mycobacterium tuberculosis in 88.64% of cases. Favorable outcomes were achieved in 90.91% of the patients who did not undergo surgery, 71.43% of those treated with debridement, 93.33% undergoing revision arthroplasty, and in 90.91% of those undergoing resection and arthrodesis. Conclusions: Clinical manifestations of knee tuberculosis and TBPJI are atypical. Thus, attention should be paid to finding the causes of increased ESRs and CRP levels, particularly in patients with weakened immune functioning, before performing TKA. Pathological examination is an effective method for diagnosing tuberculosis, although sending multiple specimens for pathological examination is necessary.

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Section: Methodsmentioning

confidence: 99%

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

Wei

Sun²,

Zhang

et al. 2020

Orthopaedic Surgery

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“…Secondly, tuberculous PJI presents in a clinically indistinguishable manner from other chronic infections caused by more common bacterial pathogens. Additionally, in some cases, M. tuberculosis may coexist with other faster-growing microorganisms, potentially leading to the underdiagnosis of tuberculosis [6][7][8][9][10]. In these cases, the persistence of symptoms, despite a correct treatment and disease progression, usually lead to the search for unusual pathogens, like mycobacteria.…”

Section: Introductionmentioning

confidence: 99%

“…In these cases, the persistence of symptoms, despite a correct treatment and disease progression, usually lead to the search for unusual pathogens, like mycobacteria. Finally, the diagnosis of these infections often experiences significant delays, due to factors such as the slow growth of the microorganism, resulting in systemic complications [9,[11][12][13]. One unanswered question revolves around the necessity of prosthesis removal and the appropriate duration of treatment required for patient cure.…”

Section: Introductionmentioning

confidence: 99%

Prosthetic Joint Infections Caused by Mycobacterium tuberculosis Complex—An ESGIAI–ESGMYC Multicenter, Retrospective Study and Literature Review

Auñon,

Salar-Vidal,

Mahillo-Fernandez

et al. 2024

Microorganisms

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Purpose: While tuberculosis remains a significant global health concern, prosthetic joint infections (PJIs) caused by members of the Mycobacterium tuberculosis complex are exceptionally rare. Our objective is to perform a retrospective search of new cases of this disease and analyze all cases available in the literature of tuberculous PJIs, aiming to detect factors that may influence patient outcomes. Methods: The ESGIAI and ESGMYC study groups were used to collect information on non-published cases of tuberculous prosthetic joint infections (PJIs). Additionally, a literature review of all published cases of tuberculous PJIs was conducted. All identified cases in the retrospective study and in the literature review were merged and included in the statistical analysis, involving both univariate and multivariate analyses. Results: Fifteen previously unreported cases of tuberculous prosthetic joint infections (PJIs) from four countries were detailed. Among them, ten patients were female, with a median age of 76 years. The hip was affected in 13 cases. Seven patients experienced co-infection with another microorganism. Treatment approaches varied, with 13 patients undergoing implant removal, one treated with DAIR (debridement, antibiotics, and implant retention), and one case was treated with an unknown treatment method. All patients received antibiotic therapy and achieved a cure. The literature review that was conducted detected 155 published cases. Univariate analysis revealed a statistical significance for previous tuberculosis, joint, and no importance of surgery for cure. Conclusions: Tuberculous prosthetic joint infection (PJI) is a rare condition, typically presenting as a localized chronic infection. Antibiotic treatment is essential for the management of these patients, but neither surgical treatment nor duration of treatment seems to have importance in the outcome.

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“…Approximately 2% of all PJI cases are caused by mycobacterial microorganisms [52]. Mycobacterium tuberculosis is a rare cause of PJI, accounting for just seven instances (0.3%) recorded in one centre during 22 years [53]. However, several studies linked early hip/knee PJI with rapidly growing nontuberculous mycobacteria (NTM), suggesting these mycobacteria as a differential diagnosis in cases of early hip/knee PJI [52,54,55].…”

Section: Introduction 1role Of Biofilm In Pjismentioning

confidence: 99%

Periprosthetic Joint Infection Diagnosis: A Narrative Review

Tsikopoulos,

Meroni

2023

Antibiotics

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Replacement of native joints aims to restore patients’ quality of life by relieving pain and improving joint function. While periprosthetic joint infection (PJI) affects a small percentage of patients, with an estimated incidence of 1–9% following primary total joint replacement, this postoperative complication necessitates a lengthy hospitalisation, extended antibiotic treatment and further surgery. It is highlighted that establishing the correct diagnosis of periprosthetic infections is critical in order for clinicians to avoid unnecessary treatments in patients with aseptic failure. Of note, the PJI diagnosis could not purely rely upon clinical manifestations given the fact that heterogeneity in host factors (e.g., age and comorbidities), variability in infection period, difference in anatomical location of the involved joint and discrepancies in pathogenicity/virulence of the causative organisms may confound the clinical picture. Furthermore, intra-operative contamination is considered to be the main culprit that can result in early or delayed infection, with the hematogenous spread being the most prevalent mode. To elaborate, early and hematogenous infections often start suddenly, whereas chronic late infections are induced by less virulent bacteria and tend to manifest in a more quiescent manner. Last but not least, viruses and fungal microorganisms exert a role in PJI pathogenesis.

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Total knee prosthesis infected withMycobacterium tuberculosis

Cited by 7 publications

References 8 publications

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

Prosthetic Joint Infections Caused by Mycobacterium tuberculosis Complex—An ESGIAI–ESGMYC Multicenter, Retrospective Study and Literature Review

Periprosthetic Joint Infection Diagnosis: A Narrative Review

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