Prosthetic Hip Loosening Due to Brucellar Infection: Case Report and Literature Review
DOI:
https://doi.org/10.15438/rr.6.4.164Keywords:
Total hip arthroplasty, Prosthetic joint infection, Brucellosis.Abstract
Context:
Brucellosis is actually considered to be the commonest zoonotic infection worldwide; conversely prosthetic infection due to brucella is extremely rare. Although diagnostic is easily achieved, management of such situations is extremely challenging.
Aims
To report the case of prosthetic hip loosening due to brucellar infection, discuss management manners and to summarize data about 19 cases reported in the literature.
Methods
We report the case of a 73-year-old woman with brucellar prosthetic hip loosening treated with 2-stage exchange of the prosthesis and prolonged double antibiotherapy
Results
At two years follow up the patient is pain free with total functional recovery and no clinical and radiographic signs of prosthetic loosening
Conclusions
Brucella should be evocated as a cause of total joint arthroplasty infection especially in patients from endemic regions and with occupational exposure. Antibiotic treatment alone can be followed if there are no signs of implant loosening. Tow stage revision should be considered in other cases.
References
Corbel MJ. Brucellosis: an overview. Emerg Infect Dis. 1997;3:213-2.
Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med. 2005;352: 2325-36.
Mousa AR, Muhtaseb SA, Almudallal DS, Khodeir SM, Marafie AA. Osteoarticular complications of brucellosis: a study of 169 cases. Rev Infect Dis. 1987;9:531-43.
Rote-Querol J. Osteo-articular sites of brucellosis. Ann Rheum Dis.1957;16:63-8.
Ariza J, Gudiol F, Valverde J et al. Brucellar spondylitis: a detailed analysis based on current findings. Rev Infect Dis. 1985;7:656-64.
Ariza J, Pujol M, Valverde J et al. Brucellar sacroiliitis: findings in 63 episodes and current relevance. Clin Infect Dis. 1993;16:761-5.
Gonzalez-Gay MA, Garcia-Porrua C, Ibanez D, Garcia-Pais MJ. Osteoarticular complications of brucellosis in an Atlantic area of Spain. J Rheumatol.1999;26:141-5.
Gotuzzo E, Alarcon GS, Bocanegra TS et al. Articular involvement in human brucellosis: a retrospective analysis of 304 cases. Semin Arthritis Rheum. 1982;12:245–55.
Khateeb MI, Araj GF, Majeed SA, Lulu AR. Brucella arthritis: a study of 96 cases in Kuwait. Ann Rheum Dis. 1990;49:994-8.
Solera J, Lozano E, Martinez-Alfaro E et al. Brucellar spondylitis: review of 35 cases and literature survey. Clin Infect Dis. 1999;29:1440-9.
Zaks N, Sukenik S, Alkan M et al. Musculoskeletal manifestations of brucellosis: a study of 90 cases in Israel. Semin Arthritis Rheum. 1995;25:97-102.
Lentino JR. Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis. 2003;36(9):1157–61.
Blom AW, Brown J, Taylor AH, et al. Infection after total knee arthroplasty. J Bone Joint Surg Br. 2004;86(5):688–91.
Blom AW, Taylor AH, Pattison G, et al. Infection after total hip arthroplasty: The Avon experience. J Bone Joint Surg Br. 2003; 85(7):956–9.
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351(16):1645–54.
Jones RB, Smith J, Hofmann A, Rogers D. Secondary infection of a total hip replacement with Brucella abortus. Orthopedics. 1983;6:184–6.
Agarwall S, Kadhi SKM, Rooney RJ. Brucellosis complicating bilateral knee arthroplasty. ClinOrthop. 1991;267:179–81.
Malizos KN, Makris CA, Soucacos PN. Total knee arthroplasties infected by Brucella melitensis: case report. Am J Orthop. 1997;26:283–5.
Orti A, Roig P, Alcala R, et al. Brucellar prosthetic arthritis in a total knee replacement. Eur J Clin Microbiol Infect Dis. 1997;16:843–5.
Ortega M, Rodriguez EC, Aguera M. Brucellosis as a cause of septic loosening of total hip arthroplasty. J Arthrop. 2002;17:384–7.
Weil Y, Mattan Y, Liebergall M, Rahav G. Brucella prosthetic joint infection: a report of 3 cases and review of the literature. Clin Infect Dis. 2003;36:81–6.
Kasim RA, Araj GF, Afeiche NE, Tabbarah ZA. Brucella infection in total hip replacement: case report and review of the literature. Scand J Infect Dis. 2004;36:65–7.
Cairo M, Calbo E, Gomez L at al. Foreign-body osteoarticular infection by Brucella melitensis. J Bone Joint Surg. 2006;88:202–4.
Tena D, Romanillos O, Rodríguez-Zapata M at al. Prosthetic hip infection due to Brucella melitensis: case report and literature review. Diagn Microbiol Infect Dis. 2007;58(4):481-5.
Tassinari E, Di Motta D, Giardina F, Traina F, De Fine M, Toni A. Brucella infection in total knee arthroplasty. Case report and revision of the literature. Chir Organi Mov. 2008;92(1):55-9.
Ruiz-Iban MA, Crespo P, Diaz-Peletier R, Rozado AM, Lopez-Pardo A. Total hip arthroplasty infected by Brucella: a report of two cases. J OrthopSurg. 2006;14(1):99-103
Erdogan H, Cakmak G, Erdogan A, Arslan H. Brucella melitensis infection in total knee arthroplasty: a case report. Knee Surg Sports Traumatol Arthrosc. 2010;18(7):908-10.
Wünschel M, Olszowski AM, Weissgerber P, Wülker N, Kluba T. Chronic brucellosis: a rare cause of septic loosening of arthroplasties with high risk of laboratory-acquired infections. Z OrthopUnfall. 2011;149(1):33-6.
Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis. 2007;7:775-86.
Sanchez-Sousa A, Torres C, Campello MG at al. Serological diagnosis of neurobrucellosis. J Clin Pathol. 1990;43:79 – 81.
Del Pozo I.L., Patel R. Infection associated with prosthetic joints, N Engl J Med. 2009;361(8):787-794.
Corbel MJ. Brucellosis in Humans and Animals. Geneva: World Health Organization, 2006.
Joint FAO-WHO expert committee on brucellosis. World Health Organ Tech Rep Ser. 1986;740:1-132.
Ariza J, Bosilkovski M, Cascio A et al. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med. 2007;4:317.
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Anis Tebourbi, Khaled Hadhri, Mohamed Ben Salah, Ramzi Bouzidi, Mondher Kooli

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.