Tuberculosis-related periprosthetic joint infections: Report of eleven cases from a single center

Tuberculosis-related periprosthetic joint infection (TB-PJI) is an uncommon but challenging complication after arthroplasty, particularly in endemic regions. Its diagnosis is often delayed due to nonspecific symptoms, prior antibiotic exposure, and culture negativity.

We retrospectively analyzed all patients with culture-confirmed Mycobacterium tuberculosis PJI diagnosed between January 2000 and January 2025 at a tertiary care center. Demographic, clinical, microbiological, histopathological, and surgical data were collected. Outcomes and follow-up status were assessed through patient interviews and review of hospital records.

Eleven patients (8 females; median age 66.8 years) were included. The knee (6/11) and hip (5/11) were the affected joints. The median interval between arthroplasty and symptom onset was 30 months. All cases were culture-positive for M. tuberculosis; GeneXpert MTB/RIF testing was performed in four patients and was positive in all. Histopathology demonstrated granulomatous inflammation in all cases, necrotizing in six. Two patients (18.1 %) had bacterial co-infections, and none had prior active tuberculosis. All patients received 10-14 months of anti-tuberculosis therapy, and nine underwent two-stage revision, while two had resection arthroplasty. Prosthesis reimplantation was achieved in nine patients. No recurrence occurred during a median follow-up of 77 months.

TB-PJI should be considered in culture-negative or refractory prosthetic infections, especially in endemic areas. Diagnostic workup should include mycobacterial culture, molecular assays, and histopathology. Prolonged anti-tuberculosis therapy combined with two-stage revision yielded excellent outcomes in our series. A diagnostic and management algorithm is proposed to facilitate early recognition and improve treatment outcomes for this rare but serious condition.