Total Knee Arthroplasty Infected by Brucella melitensis: Septic Loosening and Long-Term Results of Two-Stage Revision Knee Arthroplasty

Fatih Karaaslan Mehmet Ayvaz

doi:10.7438/1584-9341-10-3-8

Abstract

Brucella infection associated with arthroplasty is a rare event. An unspecific clinical symptomatology is associated with unclear radiographic signs of periprosthetic bone halisteresis. Only a positive anamnesis combined with an antibiogram of the joint liquid and a high serum antibody titer can lead to a definitive diagnosis. We herein report a case of Brucella melitensis infection in a patient who underwent total knee arthroplasty 2 years earlier. Plain radiography and bone scintigraphy confirmed septic loosening. The patient was successfully treated with two-stage revision arthroplasty.

Highlights

Infection following total knee arthroplasty (TKA) is one of the most common and important complications in orthopedic surgery and is the second most common cause of surgical revision [1]. Most of these infections are caused by coagulase-negative staphylococci or Staphylococcus aureus [1]
The incidence of infection following primary total hip or knee arthroplasty varies from 1.0% to 5.6% [1,2,6] and is mainly caused by aerobic Gram-positive microorganisms including coagulase-negative staphylococci and Staphylococcus Aureus
Brucellosis is a systemic infection with nonspecific symptoms such as sweating, anorexia, fatigue, weight loss, fever, lymphadenopathy, and hepatosplenomegaly [7]

Summary

Introduction

Infection following total knee arthroplasty (TKA) is one of the most common and important complications in orthopedic surgery and is the second most common cause of surgical revision [1]. Most of these infections are caused by coagulase-negative staphylococci or Staphylococcus aureus [1]. We present the long-term results of two-stage revision knee arthroplasty due to TKA infection by Brucella melitensis. Removal of the prosthetic components and cement and application of an antibiotic-loaded spacer (doxycycline and rifampicin -impregnated) were performed in the first stage (Figure 2). The results of a Brucella agglutination test at that time were negative

Discussion

Conclusion

Findings

Conflict of interest