Summary
Two cases of septic loosening due to a tuberculosis infection occurred 18 months and 14 years after total hip arthroplasties. The primary source was pulmonary tuberculosis. Treatment was by removal of the prosthesis and radical debridement with the local implantation of gentamicin PMMA beads, followed by antituberculosis chemotherapy for one year. In the first case, a revision arthroplasty was carried out 20 months later; the second was reconstructed with a vastus lateralis transposition one month later. There was no recurrence of infection after a follow up of 3 and 2 years respectively. Although this is a rare complication, the possibility must be born in mind. Early diagnosis and treatment of pulmonary tuberculosis may prevent the secondary infection of a total hip arthroplasty.
Résumé
Deux cas d'infection tuberculeuse tardive sont survenus respectivement 18 mois et 14 ans après arthroplastie totale de hanche. Une tuberculose pulmonaire a été l'origine de la contamination de la hanche. Les infections ont été soignées par ablation de la prothèse et nettoyage suivi d'implantation locale de billes de ciment additionnées d'antibiotique et d'un an de chimiothérapie anti-tuberculeuse. Le premier cas a été reconstruit par arthroplastie totale 20 mois plus tard, et le deuxième a été l'objet d'une transplantation musculaire à l'aide du vaste externe, un mois plus tard. Il n' y a pas eu de récidive de l'infection après deux ans dans un cas et trois ans dans l'autre. Il paraît utile de rappeler l'existence de cette rare complication. Le diagnostic et le traitement précoce de la tuberculose pulmonaire peut éviter l'ensemencement secondaire d'une arthroplastie totale de hanche.
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Ueng, W.N., Shih, C.H. & Hseuh, S. Pulmonary tuberculosis as a source of infection after total hip arthroplasty. International Orthopaedics 19, 55–59 (1995). https://doi.org/10.1007/BF00184916
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DOI: https://doi.org/10.1007/BF00184916