[Septic loosening of a Wagner revision stem provoked by Mycobacterium tuberculosis].
Only a few cases of specific tuberculous infections of total hip arthroplasties have been published. We report the case of a 66-year-old male patient who received a cementless total hip arthroplasty due to osteoarthritis of the left hip in 1990. Four years later, revision arthroplasty with a Wagner revision stem was performed because of aseptic loosening. In 1995 revision of a loosened acetabular cup was necessary. In 1996 we saw the patient for the first time in our outpatient unit. He complained of increasing pain in the region of the left hip. X-rays showed loosening of the Wagner stem. Aspiration of the synovial fluid of the left hip revealed an infection with mycobacterium tuberculosis (radioimmunoassay). There were no signs of tuberculous infection in the patient's history. Treatment consisted of removal of the prosthesis followed by antituberculosis chemotherapy for 12 months with rifampicin, ethambutol, isoniazid, and pyrazinamide. In April 2001 revision of the left hip joint and implantation of a MRP titanium revision stem and reconstruction of the acetabulum with an acetabular reconstruction ring was done. Until today the patient exhibits no signs of recurrence of the tuberculous infection.
Schuh
A
A
Orthopädische Klinik Rummelsberg, Schwarzenbruck. Schuh-Alexander@t-online.de
Zeiler
G
G
D000077:Acetabulum / Q000601:surgery; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004977:Ethambutol / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy; D011718:Pyrazinamide / Q000008:administration & dosage / Q000627:therapeutic use; D011863:Radioimmunoassay; D012086:Reoperation; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use; D013582:Synovial Fluid / Q000382:microbiology; D013997:Time Factors; D014025:Titanium; D014376:Tuberculosis / Q000188:drug therapy
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D014025:Titanium; D007538:Isoniazid; D012293:Rifampin