Prosthetic Knee Infection in the Young Immigrant Patient—Do Not Forget Tuberculosis!

Klein, Gregg R.; Jacquette, Germaine

doi:10.1016/j.arth.2011.09.020

Cited by 18 publications

(18 citation statements)

References 16 publications

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“…The latter may persist in a chronic state[ 20 , 22 , 23 , 25 , 26 , 34 , 35 ], reemerge upon the reactivation of previous M . tuberculosis arthritis[ 16 , 17 , 36 ], or persist as misdiagnosed arthritis[ 18 , 24 ] ( Table 4 ). M .…”

Section: Discussionmentioning

confidence: 99%

Two-stage revision arthroplasty for Mycobacterium Tuberculosis periprosthetic joint infection: An outcome analysis

Chang

et al. 2018

PLoS ONE

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BackgroundMycobacterium tuberculosis periprosthetic joint infection (TBPJI) is a rare complication of hip/knee joint arthroplasty. The outcomes of hip/knee TBPJI treatment are still unreported. The objective of this study was to investigate the outcomes of hip/knee TBPJI following treatment with two-stage exchange arthroplasty.Materials and methodsFrom 2003 to 2013, 11 patients with TBPJI (six hips and five knees) were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidities, microbiological data, duration of symptoms, and types of antibiotic used in bone cement.ResultsAt the most recent follow-up, the success rate of two-stage exchange arthroplasty was 63.3% (7 of 11). All five knee treatments resulted in infection eradication and successful prosthesis reimplantation. However, only two hip TBPJI treatments resulted in successful outcomes; two patients died and two experienced chronic infection. Overall, secondary bacterial infections were common in patients with TBPJI (5 of 11 cases, 45.5%). Streptomycin in bone cement increased the success rate (83.33% vs. 40%).ConclusionMore than one third of the patients treated with two-stage exchange arthroplasty for TBPJI showed infection relapse or uncontrolled infection. Streptomycin-loaded interim cement spacers appeared to help ensure successful treatment. Routine M. tuberculosis culture is recommended when treating TBPJI in areas of high tuberculosis prevalence.

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Section: Discussionmentioning

confidence: 99%

Two-stage revision arthroplasty for Mycobacterium Tuberculosis periprosthetic joint infection: An outcome analysis

Chang

et al. 2018

PLoS ONE

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“…Tubercular prosthetic joint infections usually result from local reactivation of quiescent infections (group A) or hematogenous spread from an extrapulmonary or a pulmonary focus (groups B and C) ( Figure 7). 2,3,9,10 Reactivation often occurs many years after an apparent symptom- free period and may be associated with surgical trauma. 3 Lack of clinical suspicion, inability to confirm the diagnosis even if clinically suspected, and coinfection with pyogenic bacteria from a chronically discharging sinus often lead to a delay in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…11 Due to the rare nature of these infections and the lack of clear evidence, formulating treatment guidelines for these prosthetic joint infections are difficult. 2,9,10,12,13 The aim of this study was to report a rare presentation of lateonset of tubercular reactivation following TKA in a patient who was treated previously for latent tuberculous infection. A comprehensive review of the literature regarding the varied onsets of presentation of tubercular prosthetic joint infections and the optimal management of these infections was also conducted.…”

Section: Discussionmentioning

confidence: 99%

“…High clinical suspicion of an indolent intra-articular infection during surgery may lead to an early diagnosis in some cases from positive cultures or histopathologic evidence of caseating granulomas in tissue samples obtained intraoperatively. 6,9,14 When these infections are diagnosed early in the postoperative period (less than 2 months postoperatively), most authors have reported eradication of infection with surgical debridement and chemotherapy without the need for prosthesis removal. 2,6,12,14 Wray and Roy, 6 in their report of 2 patients at mean follow-up of 3 years (range, 1.5-5 years), found complete eradication of tubercular prosthetic joint infection of the knee with a 12-month course of antitubercular chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…6,8 However, others believe that a 2-stage revision TKA with an extended course of antitubercular chemotherapy is necessary to eradicate the disease. 1,9 Currently, a paucity exists of reports that have comprehensively described the varied presentations and the treatment options for tubercular reactivation in the prosthetic knee joint. [1][2][3][4][5] The current report presents a case of late-onset prosthetic joint tubercular infection in a patient who had a prior history of treated latent tuberculosis.…”

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Tubercular Prosthetic Knee Joint Infection

et al. 2013

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This article reports a rare case of late-onset tubercular infection following total knee arthroplasty in a 60-year-old woman who had been treated with a full course of antitubercular therapy for latent tuberculosis almost 25 years ago. Because no clear guidelines exist for optimal management of disease reactivation in the prosthetic knee joint, the authors performed a literature review and attempted to provide a treatment algorithm based on the time of presentation. Two modes of presentation were identified for unsuspected tubercular prosthetic joint infections based on the onset of symptoms and time to diagnosis: an early-onset presentation that occurs within the first 6 to 8 weeks postoperatively and a late-onset presentation that usually manifests after 8 weeks. Early-onset presentations often can be treated with standard antitubercular chemotherapy alone, whereas late-onset presentation may require 2-stage reimplantation under cover of antitubercular medications. This report also highlights the fact that despite adequate treatment of latent tuberculosis, patients may remain at risk of prosthetic joint infection following total knee arthroplasty.

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Total knee arthroplasty for the management of joint destruction in tuberculous arthritis

Öztürkmen¹,

Üzümcügil²,

Karamehmetoğlu³

et al. 2013

Knee Surg Sports Traumatol Arthrosc

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Prosthetic Knee Infection in the Young Immigrant Patient—Do Not Forget Tuberculosis!

Cited by 18 publications

References 16 publications

Two-stage revision arthroplasty for Mycobacterium Tuberculosis periprosthetic joint infection: An outcome analysis

Two-stage revision arthroplasty for Mycobacterium Tuberculosis periprosthetic joint infection: An outcome analysis

Tubercular Prosthetic Knee Joint Infection

Total knee arthroplasty for the management of joint destruction in tuberculous arthritis

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