SA Orthopaedic Journal
On-line version ISSN 2309-8309
BURGER, JD and DE JONGH, H. Total knee replacement infected with Mycobacterium tuberculosis: A case study and review of the literature. SA orthop. j. [online]. 2013, vol.12, n.2, pp. 64-68. ISSN 2309-8309.
Prosthetic joint infection is an infrequent complication occurring in approximately 1% of primary joint arthroplasty.1,2 It often is a devastating complication necessitating prolonged treatment and multiple surgeries.3 The majority are due to staphylococcal infections followed by Gram-negative bacilli and Streptococcus species, but atypical and zoonotic infections do occur.4,5 Mycobacterium tuberculosis infections of prosthetic joints have been described in sporadic reports. Osteoarticular tuberculosis (TB) historically accounts for between 1% and 4% of all TB infections, making it one of the more common extra-pulmonary sites.6 During the past decade reported TB infections in South Africa have doubled and the estimated incidence over the last 15 years has risen three-fold. This staggering rise is exclusively due to the Human Immunodeficiency Virus (HIV) pandemic with more than half being HIV positive.7 However, only 20% of osteoarticular TB is associated with pulmonary disease.6,8 Despite significant efforts TB remains one of the most challenging global health problems affecting not only developing countries. Its relevance has been promoted by recent reports from, among others, the United Kingdom and the Netherlands, indicating that there has been a reversal of its decline in these developed countries which directly relates to immigration.9,10,11 The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has further complicated its treatment, with the largest number of reported XDR tuberculosis cases coming from South Africa.12
Keywords : total knee replacement; Mycobacterium tuberculosis; peri-prosthetic joint infection; review.