High Tibial Osteotomy for Medial Compartment Knee Osteoarthritis : A Randomized Trial With Parallel Preference Arm.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosures: Disclosure forms are available with the article online. 15. Infection. 2018 Feb;46(1):55-68. doi: 10.1007/s15010-017-1085-1. Epub 2017 Oct 30. Tubercular prosthetic joint infection: two case reports and literature review. Veloci S(1), Mencarini J(1), Lagi F(1), Beltrami G(2), Campanacci DA(2)(3), Bartoloni A(1)(4), Bartalesi F(5). Author information: (1)Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. (2)Orthopaedic Oncology Unit, Careggi Hospital, Florence, Italy. (3)Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. (4)Infectious and Tropical Diseases Unit, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy. (5)Infectious and Tropical Diseases Unit, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy. bartalesif@aou-careggi.toscana.it. PURPOSE: Tubercular prosthetic joint infection (TB-PJI) is an uncommon complication. Lack of evidence of systemic tuberculosis and clinical suspicion could bring a delay in the time of the diagnosis. The aims of this study are to underline the importance of awareness and suspicion of mycobacterial infection in the differential diagnosis in PJI and to evaluate the appropriateness of different therapeutic options. METHODS: Case report and literature review. RESULTS: We report two cases of TB-PJI after total knee arthroplasty in Caucasian patients without prior history of tubercular disease or exposure. In both cases, the diagnosis was obtained years after the onset of symptoms. Despite that, both patients improved during antitubercular treatment (a four-drug regimen consisting of rifampicin, isoniazid, ethambutol, and pyrazinamide for 2 months, followed by rifampicin and isoniazid). Moreover, after an 18-month course of treatment, there was no need for surgical therapy. The result of the literature review allows us to identify 64 cases of TB-PJI. Many differences in both medical and surgical management have been found, among those reviewed cases. CONCLUSIONS: Considering our experience and the literature review, we recommend considering a conservative approach (debridement and adequate antituberculous chemotherapy) as a suitable and safe option. DOI: 10.1007/s15010-017-1085-1