Unusual presentation of Mycobacterium Tuberculosis Prosthetic Joint Infection (TBPJI) after Total Knee Arthroplasty (TKA) -A case report

Background: Mycobacterium tuberculosis infrequently causes Prosthetic Joint Infections (PJI). A rare infection, skeletal tuberculosis accounts for about 2% of cases of tuberculosis overall.

Aims: We report a case of tubercular prosthetic joint infection one year after Total Knee Arthroplasty (TKA), with no previous history of Tuberculosis (TB).

Methods: One year following a total knee replacement for osteoarthritis of right knee, a 51-years-old female patient complained of pain and swelling in the knee. On examination, her knee showed signs of swelling, warmth, and erythema. The initial blood investigations were abnormal (raised CRP and ESR). Mycobacterium tuberculosis infection was diagnosed by a subsequent culture and histological analysis of the synovial tissue. Debridement was done and Anti-Tubercular Therapy (ATT) started. The patient demonstrated a significant improvement in signs, symptoms, and functional outcomes and recovered uneventfully.

Results: High suspicion of prosthetic tubercular infection and timely intervention allowed the patient early and eventless recovery and could save the prosthesis and knee function.

Conclusion: Tubercular infection after total knee arthroplasty is a rare entity. A good clinical and functional outcome can be achieved by proper management, including ATT and, if necessary, surgical intervention. The detection of tuberculosis of the knee might be complicated particularly in patients without obvious pulmonary tuberculosis and discharging sinuses.