Total hip replacement prosthesis infected by Mycobacterium tuberculous

We examined the diagnostic and therapeutic approaches used for two patients with loosened total hip prostheses who developed Mycobacterium tuberculosis infection. Revision total hip arthroplasty (THA) was performed in one patient. The prosthesis was left in situ in the second patient due to lack of sufficient bone stock. Medical treatment was given. The diagnosis was established on direct examination of bacteriological samples and culture on specific media. Polymerase chain reaction identified the Mycobacterium tuberculosis complex. Non-specific granulomas were observed on the histology sections. For us, management of overt tuberculosis involving a THA depends on the quality of the fixation. If the prosthesis remains stable, medical treatment can be sufficient. If the prosthesis loosens, definitive ablation must be considered with possible revision THA later. Exceptionally, a loosened implant may be left in situ if the remaining bone stock is insufficient. Minimal duration of anti-tuberulosis treatment is six months.