title: Late onset Mycobacterium tuberculosis infection after total knee arthroplasty: a systematic review and pooled analysis.
abstract: BACKGROUND
  Mycobacterium tuberculosis (TB) is a rare cause of prosthetic joint infection. The purpose of this study was to provide an evidence-based summarization of the outcomes of TB infection after total knee arthroplasty (TKA) with a pooled analysis of the reported cases.
  
  
  METHODS
  We conducted a systematic review of published studies that have evaluated the outcomes of prosthetic knee joint infections due to TB. A structured literature review of multiple databases referenced articles from January 1950 to July 2012.
  
  
  RESULTS
  A total of 15 patients were identified from 13 published studies. Tuberculosis was confirmed in all cases by histological examination and positive culture or histochemical stain/polymerase chain reaction (PCR). Treatment consisted of anti-tuberculosis medication therapy (AMT) only in 2 patients, AMT plus debridement and retention of the arthroplasty in 5 patients, and AMT plus removal/exchange of the arthroplasty in 8 patients. The average follow-up after TB infection was 29 months (range 1-96 months) and there were 3 deaths, giving a crude death rate of 0.7 per 100 person-months. At the final follow-up, the outcomes of TB infection after TKA were good except in the 3 patients who died.
  
  
  CONCLUSIONS
  TB infection after TKA is a rare disease, however good clinical outcomes can be achieved with proper management including AMT and surgical intervention.
authors.affiliation: From the Department of Orthopaedics, New Jersey Medical School , Newark, NJ , USA.
authors.forename: Seung-Ju
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jong Hun
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents