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Mycobacterial periprosthetic joint infection after primary total knee arthroplasty

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Abstract

Purpose

Mycobacterial periprosthetic joint infection (PJI) is very rare and is generally associated with an immunosuppressive environment. Few large-scale studies of this unusual PJI have been conducted. The current study was performed to assess the clinical features and outcomes following two-stage re-implantation for mycobacterial PJI after primary total knee arthroplasty (TKA).

Methods

We conducted a retrospective review of data collected from our database involving ten cases of two-stage re-implantation manifesting mycobacterial PJI. Patients were followed for at least five years or until recurrent infection. The mean follow-up duration in patients who remained free of infection was 7.5 years (range 5–9.5 years).

Results

Seven patients (70%) belonged to the American Society of Anesthesiologists’ grade 3 or 4. The surgical protocol entailed resection arthroplasty and cement spacer insertion with vigorous debridement, followed by at least six weeks of systemic antimicrobial therapy and delayed re-implantation in all patients. The median duration from resection arthroplasty to re-implantation was 5.3 months (range 2–10.5 months). Following re-implantation, five patients with Mycobacterium fortuitum were treated with amikacin for six weeks and oral clarithromycin for three months. Five patients infected with M. tuberculosis received anti-tuberculosis medications immediately after pathogen isolation, for a period of 12 months.

Conclusion

Mycobacterial PJI can be treated successfully via resection arthroplasty and delayed re-implantation combined with proper antimicrobial agents. Suspicious infection or loosening after primary TKA, particularly in an immunosuppressive environment, warrants the attention of an orthopedic surgeon to consider the possibility of unusual PJI.

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Authors and Affiliations

  1. Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul, 07999, Republic of Korea

    Bo-Hyun Hwang, Su-Chan Lee & Hye-Sun Ahn

  2. Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Bo-Hyun Hwang & Seong-Hwan Moon

  3. Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA

    Alvin Ong

Authors
  1. Bo-Hyun Hwang
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  2. Su-Chan Lee
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  4. Hye-Sun Ahn
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  5. Seong-Hwan Moon
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Contributions

BHH and SCL initiated the study and set up the design. BHH and HSA collected and analyzed data. BHH wrote the manuscript. BHH, AO, and SHM revised every version. All authors reviewed the final manuscript. All authors agreed to be accountable for all aspects of the work.

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Correspondence to Su-Chan Lee.

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The authors’ institutional review board approved this study.

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Informed consent was obtained by each patient in this study.

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The authors declare no competing interests.

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Level of evidence: Level IV, retrospective study

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Hwang, BH., Lee, SC., Ong, A. et al. Mycobacterial periprosthetic joint infection after primary total knee arthroplasty. International Orthopaedics (SICOT) 45, 3055–3062 (2021). https://doi.org/10.1007/s00264-021-05029-x

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  • DOI: https://doi.org/10.1007/s00264-021-05029-x

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