Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2022; 13(5): 503-514
Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.503
Prosthetic joint infection of the hip and knee due to Mycobacterium species: A systematic review
Asep Santoso, Krisna Yuarno Phatama, Sholahuddin Rhatomy, Nicolaas Cyrillus Budhiparama
Asep Santoso, Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Surakarta and Prof. Dr. R. Soeharso Orthopaedic Hospital, Sukoharjo 57162, Indonesia
Krisna Yuarno Phatama, Department of Orthopaedic and Traumatology, Universitas Brawijaya, Saiful Anwar General Hospital, Malang 65112, Indonesia
Sholahuddin Rhatomy, Department of Orthopaedic and Traumatology, Universitas Gadjah Mada, Yogyakarta and Dr. Soeradji Tirtonegoro General Hospital, Klaten 57424, Indonesia
Nicolaas Cyrillus Budhiparama, Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation at Medistra Hospital, Jakarta 12950, Indonesia
Nicolaas Cyrillus Budhiparama, Faculty of Medicine, Universitas Airlangga, Jawa Timur 60132, Indonesia
Nicolaas Cyrillus Budhiparama, Department of Orthopaedics, Leiden University Medical Center, Leiden 2333, Netherlands
Author contributions: Santoso A, Phatama KY, and Rhatomy S contributed to the data collection and analysis; Santoso A and Phatama KY wrote the paper; Budhiparama NC contributed to the study design, analysis and finalization.
Conflict-of-interest statement: All of the author have none to disclose.
PRISMA 2009 Checklist statement: This study has been presented following the PRISMA 2019 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nicolaas Cyrillus Budhiparama, MD, PhD, Professor, Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation at Medistra Hospital, Jl. Jendral Gatot Subroto Kav. 59, Jakarta 12950, Indonesia. n.c.budhiparama@gmail.com
Received: July 4, 2021
Peer-review started: July 4, 2021
First decision: October 18, 2021
Revised: November 7, 2021
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 18, 2022
Processing time: 312 Days and 16.6 Hours
Abstract
BACKGROUND

Mycobacterium species (Mycobacterium sp) is an emerging cause of hip and knee prosthetic joint infection (PJI), and different species of this organism may be responsible for the same.

AIM

To evaluate the profile of hip and knee Mycobacterium PJI cases as published in the past 30 years.

METHODS

A literature search was performed in PubMed using the MeSH terms “Prosthesis joint infection” AND “Mycobacterium” for studies with publication dates from January 1, 1990, to May 30, 2021. To avoid missing any study, another search was performed with the terms “Arthroplasty infection” AND “Mycobacterium” in the same period as the previous search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was used to evaluate the included studies for further review. In total, 51 studies were included for further evaluation of the cases, type of pathogen, and treatment of PJI caused by Mycobacterium sp.

RESULTS

Seventeen identified Mycobacterium sp were reportedly responsible for hip/knee PJI in 115 hip/knee PJI cases, whereas in two cases there was no mention of any specific Mycobacterium sp. Mycobacterium tuberculosis (M. tuberculosis) was detected in 50/115 (43.3%) of the cases. Nontuberculous mycobacteria (NTM) included M. fortuitum (26/115, 22.6%), M. abscessus (10/115, 8.6%), M. chelonae (8/115, 6.9%), and M. bovis (8/115, 6.9%). Majority of the cases (82/114, 71.9%) had an onset of infection > 3 mo after the index surgery, while in 24.6% (28/114) the disease had an onset in ≤ 3 mo. Incidental intraoperative PJI diagnosis was made in 4 cases (3.5%). Overall, prosthesis removal was needed in 77.8% (84/108) of the cases to treat the infection. Overall infection rate was controlled in 88/102 (86.3%) patients with Mycobacterium PJI. Persistent infection occurred in 10/108 (9.8%) patients, while 4/108 (3.9%) patients died due to the infection.

CONCLUSION

At least 17 Mycobacterium sp can be responsible for hip/knee PJI. Although M. tuberculosis is the most common causal pathogen, NTM should be considered as an emerging cause of hip/knee PJI.

Keywords: Mycobacterium species; Prosthetic joint infection; Hip; Knee; Systematic review

Core Tip: Prosthetic joint infection (PJI) is a difficult complication after total hip/knee arthroplasty. Mycobacterium species (Mycobacterium sp) is one of the emerging causes of hip and knee PJI, and various species could be responsible for it. This study aimed to evaluate the profile of hip and knee Mycobacterium PJI cases published in the past 30 years. This study resulted the information regarding the distribution of Mycobacterium sp that related to PJI hip/knee. This paper also evaluated the disease course, treatment and outcome of Mycobacterium PJI.