Case Report

Prosthetic Joint Infection by Mycobacterium tuberculosis: An Unusual Case Report with Literature Review

Authors: Fares J. Khater, MD, Imran Q. Samnani, MD, Jay B. Mehta, MD, FCCP, Jonathan P. Moorman, MD, PhD, James W. Myers, MD

Abstract

Prosthetic joint infection with Mycobacterium tuberculosis usually involves the hips or knees and can result from either local reactivation, or less often from hematogenous spread. Predisposing conditions include rheumatoid arthritis, chronic steroid use and pulmonary diseases. The most common symptom at presentation is pain, and the most common physical finding is joint swelling and/or a draining sinus tract. The sedimentation rate is helpful when elevated but is nonspecific, and initial skin testing is only helpful when positive. The diagnosis depends on culture and histologic examination of tissue. Removal of the joint combined with oral antituberculous treatment is necessary when the infection is discovered greater than six weeks post joint replacement. Early diagnosis leads to decreased morbidity. Tuberculous infection of prosthetic joints is a rare disease and its diagnosis depends on a high degree of clinical suspicion.


Key Points


* Mycobacterium tuberculosis infection can occur in prosthetic joints, often in the setting of steroid use.


* A high degree of clinical suspicion is necessary to make a diagnosis of mycobacterial prosthetic joint infection.


* Aggressive diagnostic and therapeutic measures, including prosthesis removal, are needed to cure mycobacterial prosthetic joint infections.

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References

1. Hecht RH, Meyers MH, Thornhill-Joynes M, et al. Reactivation of tuberculous infection following total joint replacement: a case report. J Bone Joint Surg Am 1983;65:1015–1016.
 
2. Harris WH, Sledge CB. Total hip and total knee replacement (1). N Engl J Med 1990;323:725–731.
 
3. Harris WH, Sledge CB. Total hip and total knee replacement (2). N Engl J Med 1990;323:801–807.
 
4. Lusk RH, Wienke EC, Milligan TW, et al. Tuberculous and foreign-body granulomatous reactions involving a total knee prosthesis. Arthritis Rheum 1995;38:1325–1327.
 
5. Atkins BL, Athanasou N, Deeks JJ, et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty: the OSIRIS Collaborative Study Group. J Clin Microbiol 1998;36:2932–2939.
 
6. McCullough CJ. Tuberculosis as a late complication of total hip replacement. Acta Orthop Scand 1977;48:508–510.
 
7. Tokumoto JI, Follansbee SE, Jacobs RA. Prosthetic joint infection due to Mycobacterium tuberculosis: report of three cases. Clin Infect Dis 1995;21:134–136.
 
8. Spinner RJ, Sexton DJ, Goldner RD, et al. Periprosthetic infections due to Mycobacterium tuberculosis in patients with no prior history of tuberculosis. J Arthroplasty 1996;11:217–222.
 
9. Gale DW, Harding ML. Total knee arthroplasty in the presence of active tuberculosis. J Bone Joint Surg Br 1991;73:1006–1007.
 
10. Lin E, Oliver S, Caspi I, et al. Hip arthroplasty in quiescent mycobacterial infection of hip. Orthop Rev 1986;15:232–236.
 
11. Levin ML. Miliary tuberculosis masquerading as late infection in total hip replacement. Md Med J1985;34:153–155.
 
12. Wolfgang GL. Tuberculosis joint infection. Clin Orthop Relat Res 1978;136:257–263.
 
13. Bryan WJ, Doherty JH Jr, Sculco TP. Tuberculosis in a rheumatoid patient: a case report. Clin Orthop 1982;171:206–208.
 
14. Johnson R, Barnes KL, Owen R. Reactivation of tuberculosis after total hip replacement. J Bone Joint Surg Br 1979;61-B:148–150.
 
15. Baldini N, Toni A, Greggi T, et al. Deep sepsis from Mycobacterium tuberculosis after total hip replacement: case report. Arch Orthop Trauma Surg 1988;107:186–188.
 
16. Wolfgang GL. Tuberculosis joint infection following total knee arthroplasty. Clin Orthop Relat Res 1985;201:162–166.
 
17. Eskola A, Santavirta S, Konttinen YT, et al. Arthroplasty for old tuberculosis of the knee. J Bone Joint Surg Br 1988;70:767–769.