Vanina Meyssonnier1, Valérie Zeller2, Stéphanie Malbos3, Beate Heym4, Luc Lhotellier5, Nicole Desplaces4, Simon Marmor5, Jean-Marc Ziza2. 1. Service de médecine interne et rhumatologie, groupe hospitalier Diaconesses CroixSaint-Simon, 125, rue d'Avron, 75960 cedex 20, Paris, France; Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses Croix Saint-Simon, 75960 cedex 20, Paris, France. Electronic address: vanina.meyssonnier@gmail.com. 2. Service de médecine interne et rhumatologie, groupe hospitalier Diaconesses CroixSaint-Simon, 125, rue d'Avron, 75960 cedex 20, Paris, France; Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses Croix Saint-Simon, 75960 cedex 20, Paris, France. 3. Service de médecine interne et rhumatologie, groupe hospitalier Diaconesses CroixSaint-Simon, 125, rue d'Avron, 75960 cedex 20, Paris, France. 4. Laboratoire de biologie médicale, groupe hospitalier Diaconesses Croix Saint-Simon, 75960 cedex 20, Paris, France; Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses Croix Saint-Simon, 75960 cedex 20, Paris, France. 5. Service de chirurgie osseuses et traumatologique, groupe hospitalier Diaconesses Croix Saint-Simon, 75960 cedex 20, Paris, France; Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses Croix Saint-Simon, 75960 cedex 20, Paris, France.
Abstract
OBJECTIVE: 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. METHODS: A single-center retrospective study of patients managed between 1987 and 2016 was performed. RESULTS: 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. CONCLUSION: 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.
OBJECTIVE: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. METHODS: A single-center retrospective study of patients managed between 1987 and 2016 was performed. RESULTS: 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. CONCLUSION: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.