Tuberculosis-related periprosthetic joint infections: Report of eleven cases from a single center.

BACKGROUND: Tuberculosis-related periprosthetic joint infection (TB-PJI) is an uncommon but challenging complication after arthroplasty, particularly in endemic regions. Its diagnosis is often delayed due to nonspecific symptoms, prior antibiotic exposure, and culture negativity.

METHODS: We retrospectively analyzed all patients with culture-confirmed Mycobacterium tuberculosis PJI diagnosed between January 2000 and January 2025 at a tertiary care center. Demographic, clinical, microbiological, histopathological, and surgical data were collected. Outcomes and follow-up status were assessed through patient interviews and review of hospital records.

RESULTS: Eleven patients (8 females; median age 66.8 years) were included. The knee (6/11) and hip (5/11) were the affected joints. The median interval between arthroplasty and symptom onset was 30 months. All cases were culture-positive for M. tuberculosis; GeneXpert MTB/RIF testing was performed in four patients and was positive in all. Histopathology demonstrated granulomatous inflammation in all cases, necrotizing in six. Two patients (18.1 %) had bacterial co-infections, and none had prior active tuberculosis. All patients received 10-14 months of anti-tuberculosis therapy, and nine underwent two-stage revision, while two had resection arthroplasty. Prosthesis reimplantation was achieved in nine patients. No recurrence occurred during a median follow-up of 77 months.

CONCLUSION: TB-PJI should be considered in culture-negative or refractory prosthetic infections, especially in endemic areas. Diagnostic workup should include mycobacterial culture, molecular assays, and histopathology. Prolonged anti-tuberculosis therapy combined with two-stage revision yielded excellent outcomes in our series. A diagnostic and management algorithm is proposed to facilitate early recognition and improve treatment outcomes for this rare but serious condition.