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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

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Two-Stage Re-revision for Tuberculosis Affecting a Revision Total Hip Arthroplasty: A Case Report.

Narayan Hulse¹

¹Department of Bone and Joints, Fortis Hospital, Bangalore, India.

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|June 5, 2025

Summary

A rare case of hip periprosthetic joint infection caused by Mycobacterium Tuberculosis was successfully treated. Early suspicion and advanced genomic sequencing aided in identifying the pathogen, leading to effective antitubercular therapy and a positive patient outcome.

Keywords:

mycobacterium tuberculosis periprosthetic joint infections re-revision hip revision total hip arthroplasty total hip arthroplasty

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Area of Science:

Orthopedic Surgery
Infectious Diseases
Genomic Medicine

Background:

Periprosthetic joint infections (PJIs) pose significant challenges in orthopedic surgery.
Tuberculosis (TB) is an uncommon but serious cause of PJIs, often requiring high clinical suspicion for diagnosis.
Revision total hip arthroplasty (THA) can be complicated by late-onset infections.

Purpose of the Study:

To report a case of a challenging tubercular periprosthetic hip infection.
To highlight the role of next-generation sequencing in identifying Mycobacterium Tuberculosis in PJIs.
To demonstrate the successful management and long-term outcome of such infections.

Main Methods:

A 68-year-old female patient with a discharging sinus and hip pain post-revision THA.
Diagnosis involved targeted next-generation sequencing to identify Mycobacterium Tuberculosis.
Treatment consisted of a 2-stage re-revision surgery followed by 9 months of antitubercular therapy.

Main Results:

Next-generation sequencing accurately identified Mycobacterium Tuberculosis as the causative agent.
The patient completed 9 months of antitubercular therapy.
At 5-year follow-up, the patient showed excellent functional recovery (Harris Hip Score 85%) with no signs of recurrent infection or prosthetic loosening.

Conclusions:

Tubercular periprosthetic hip infections require a high index of suspicion for timely diagnosis.
Genomic sequencing is a valuable tool for identifying the causative organism in complex PJIs.
Multimodal treatment including surgery and prolonged antitubercular therapy can lead to successful outcomes in these rare cases.