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Two-stage revision for treatment of tuberculous prosthetic hip infection: an outcome analysis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

A Correction to this article was published on 03 August 2022

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Abstract

Objectives

Prosthetic joint infections (PJI) and especially tuberculosis (TB) PJI are rare diseases and hard to cure. The effectiveness of treatments for tuberculous PJI still remains a problem. The objective of this research was to indicate the success of two-stage revision replacement and also giving the associated criteria.

Methods

From 2015 to 2020, five patients with tuberculous PJI were treated with two-stage revision at Cho Ray hospital, Vietnam. We collected the dataset which included demographic data, the interval from the time of joint replacement to reported infection, records of tuberculous PJI, administration of anti-TB medications (duration, months), history of operation(s), duration of follow-up, and specific type(s) of antibiotics loaded in bone cement. The approval for this study was made by the institutional review board from Cho Ray Hospital, Vietnam. We conducted a literature review based on the keywords “PJI” and “TB” on PubMed.

Results

Five patients [median age 66 years (range 35–84)] had found tuberculous PJI. The median time from arthroplasty to diagnosis was 19 months (range 4–48). The diagnosis was confirmed by joint aspirates or synovial tissue. Positive PCR was also reported in all cases. The average duration of anti-tuberculosis polytherapy administration was 14.4 months. The operative techniques on five patients included debridement and using spacer loaded with 2 g streptomycin (and 2 g vancomycin if they got a coinfection) for 1 pack of bone cement, and revision arthroplasty. In most cases, the outcome of treatment using two-stage revision replacement was 80%. Overall, the auxiliary bacterial infections were recognized in three patients with tuberculous PJI and Staphylococcus aureus. Streptomycin and vancomycin were loaded in a cement spacer to increase the success rate, and tuberculous PJI was controlled for all patients.

Conclusion

Tuberculous PJI can be controlled with two-stage revision replacement with an antibiotic-loaded cement spacer that is molded intraoperatively with custom mold and prolonged anti-tuberculosis treatment in all cases.

Level of evidence

IV.

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Acknowledgements

Truong Nguyen Khanh Hung is the submitting and corresponding author. This study was conducted at the Orthopedic and Trauma Department, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam

    Tuan Van Le, Tran Binh Duong, Tran Phuoc Binh, Dao Thanh Tu, Pham Phuoc Tho, Le Nguyen Binh, Huynh Phuoc Hau & Truong Nguyen Khanh Hung

  2. Department of Orthopedic Surgery, Hue Central Hospital, Hue, Vietnam

    Quyen Nguyen Quang Ton

  3. Faculty of Pharmacy, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam

    Tan Huyn

  4. International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan

    Kha Quang Hien & Truong Nguyen Khanh Hung

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  1. Tuan Van Le
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Contributions

Duong and Tran Phuoc Binh drafted the main manuscript. Le Nguyen Binh, Tu, and Tho managed and followed up all the cases. Hung, Hien, and Tuan revised the manuscript critically and reviewed the literature. All authors are surgeons who operated for all patients. Moreover, they all read and approved the final manuscript.

Corresponding author

Correspondence to Truong Nguyen Khanh Hung.

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Van Le, T., Duong, T.B., Hien, K.Q. et al. Two-stage revision for treatment of tuberculous prosthetic hip infection: an outcome analysis. Eur J Orthop Surg Traumatol 33, 645–651 (2023). https://doi.org/10.1007/s00590-022-03317-9

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