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

Abstract

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.

Does the Effectiveness and Mechanical Strength of Kanamycin-Loaded Bone Cement in Musculoskeletal Tuberculosis Compare to Vancomycin-Loaded Bone Cement

“…In spite of equivalent antimycobacterial activities of streptomycin and kanamycin between former and this experiment, there have been differences in clinical indication between streptomycin and kanamycin depending on the regional characteristics of resistance [27e29]. In clinical outcomes of 2-stage revision arthroplasty for tuberculosis periprosthetic joint infection, the impregnation of streptomycin in cement spacer resulted in successful outcomes [12]. In their data, because 5 patients who diagnosed with tuberculosis periprosthetic joint infection had coinfection with gram-positive bacterial species, even streptomycin has been impregnated in combination with vancomycin to cover both strains [12].…”

“…In clinical outcomes of 2-stage revision arthroplasty for tuberculosis periprosthetic joint infection, the impregnation of streptomycin in cement spacer resulted in successful outcomes [12]. In their data, because 5 patients who diagnosed with tuberculosis periprosthetic joint infection had coinfection with gram-positive bacterial species, even streptomycin has been impregnated in combination with vancomycin to cover both strains [12]. Recently, World Health Organization has updated the treatment guidelines for multidrug-resistant and rifampicinresistant tuberculosis, which excluded kanamycin because of the increased rate of resistance and side effects in the recent time, and it included streptomycin, which was not recommended in previous version of treatment guideline [11,30].…”

“…In a clinical result, a combination of antibiotics to cover a broad spectrum of bacteria and tuberculosis demonstrated satisfactory results [12e14]. An antimycobacterial agent that is able to control both bacterial and tuberculosis infection might be more beneficial because of the unclear diagnosis until confirmation of the tissue and specimen obtained during operation [12]. However, there has been limited information about the suitability of kanamycin when mixed with bone cement.…”

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

“…Cases of first-stage revisions have not been reported in the literature; two-stage revision arthroplasty, however, is a commonly reported strategy. Chang et al recommended using antituberculosis drugs for at least 10 months after debridement and implant spacers 24 . After the infection symptoms and inflammation index have completely subsided, the prosthesis can be implanted during the second stage; otherwise, patients needed debridement and implant spacers again.…”

Synthesis and Characterization of Nanohydroxyapatite-Gelatin Composite with Streptomycin as Antituberculosis Injectable Bone Substitute

“…By using a suspending agent like hydroxyl propyl methyl cellulose (HPMC), the IBS could be synthesized as mentioned by Weiss et al (2007) and Shen et al (2014) in their study [9–11]. The addition of antibiotic such streptomycin could help the healing process in the spinal tuberculosis case [12].…”