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[Total hip replacement prosthesis infected by Mycobacterium tuberculous]
Summary
Managing Mycobacterium tuberculosis infection in patients with total hip arthroplasty (THA) depends on prosthesis stability. Stable implants may only require medical treatment, while loosened ones necessitate surgical intervention or, exceptionally, retention with medical therapy.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Tuberculosis (TB) is a significant global health concern.
- Mycobacterium tuberculosis infection can affect prosthetic joints, including total hip arthroplasty (THA).
- Diagnosis and management of TB in THA patients present unique challenges.
Observation:
- Two cases of Mycobacterium tuberculosis infection in patients with loosened total hip prostheses were analyzed.
- Diagnostic methods included direct bacteriological examination, culture, polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex, and histology.
- Histology revealed non-specific granulomas.
Findings:
- One patient underwent revision total hip arthroplasty.
- The second patient, with insufficient bone stock, was treated medically with the prosthesis left in situ.
- Management decisions were based on prosthesis fixation quality.
Implications:
- For stable total hip prostheses with tuberculosis, medical treatment may suffice.
- Loosened implants typically require definitive ablation, potentially followed by revision THA.
- In rare cases of insufficient bone stock, a loosened implant can be retained with medical management.
- A minimum of six months of anti-tuberculosis treatment is recommended.