title: Total hip arthroplasty infected by Brucella: a report of two cases.
abstract: Infection caused by Brucella following total joint arthroplasty is very rare. We present 2 cases of brucellar infection following total hip arthroplasty (THA). A 66-year-old woman who had prolonged contact with cattle presented with pain at the thigh and groin areas. The patient had undergone an uncemented THA for a hip fracture 3 years previously. Cultures of articular liquid were positive for Brucella abortus. The implant was loosened and was managed with a 2-stage re-implantation. A 71-year-old man presented with painless suppuration of the hip joint through the scar from previous surgeries. Radiography demonstrated a well-integrated THA. When postoperative cultures were found positive for Brucella melitensis, antibiotic treatment of rifampicin 900 mg, streptomycin 1 g, and doxycycline 200 mg daily were prescribed. At 5.5-year and 5-year follow-up, respectively, both patients were asymptomatic and free of infection with well-integrated implants. As the Brucella pathogen is highly susceptible to antibiotics, standard 2-stage revision arthroplasty for loosened implant or debridement and antibiotic treatment for well-fixed implant should suffice.
authors.affiliation: Departamento de Cirugia Ortopedica y Traumatologia, Hospital Ramon y Cajal, Madrid, Spain. drmri@hotmail.com
authors.forename: M A
authors.initials: MA
authors.lastname: Ruiz-Iban
authors.forename: P
authors.initials: P
authors.lastname: Crespo
authors.forename: R
authors.initials: R
authors.lastname: Diaz-Peletier
authors.forename: A M
authors.initials: AM
authors.lastname: Rozado
authors.forename: A
authors.initials: A
authors.lastname: Lopez-Pardo
mesh_terms: D000368:Aged; D000818:Animals; D019644:Arthroplasty, Replacement, Hip; D002003:Brucella abortus; D017347:Brucella melitensis; D002006:Brucellosis / Q000175:diagnosis / Q000601:surgery* / Q000635:transmission; D002007:Brucellosis, Bovine / Q000635:transmission; D002417:Cattle; D005260:Female; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation