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This paper presents four case reports and a systematic review examining the diagnosis and treatment of periprosthetic joint infection (PJI) caused by Brucella spp. The review included 61 patients and found that serological antibody tests were the most sensitive diagnostic tool, while treatment strategies varied based on implant stability, ranging from antibiotic therapy alone to one- or two-stage revision with combined antibiotic therapy. No recurrence was reported across the included cases.
Serological testing should be prioritized in suspected Brucella PJI, and treatment algorithms should be tailored to implant stability, with revision indicated for loose prostheses.
Background Periprosthetic joint infection (PJI) caused by Brucella spp. is an exceedingly rare occurrence, leading to a lack of consensus regarding its diagnosis and treatment. This review mainly aimed to assess the diagnosis and treatment strategy of Brucella-induced PJI. Methods We summarized the data by reporting 4 cases from the Hexi area of China and conducting a systematic review. A comprehensive literature search was performed in PubMed, Web of Science, Embase, and the Chinese Biology Medicine database for relevant publications using predefined search terms. Included studies were case reports or series on human Brucella-induced PJI that described patient outcomes. Data on demographics, diagnosis, treatment, and outcomes were extracted and analyzed. Results A total of 61 patients of Brucella-related PJI were summarized. Serological antibody tests provided the best diagnostic yield with a 100% positive rate (35/35), compared to lower sensitivities for joint aspiration culture (53.84%, 21/39) and blood culture (41.67%, 5/12). In the presence of radiological implant loosening, 32 patients underwent one- or 2-stage revision with combination antibiotic therapy. For 29 patients without loosening, treatment included antibiotic therapy alone or combined with drainage and debridement or revision. No recurrence was reported at the end of the follow-up. Conclusions Preoperative serological tests are prioritized for diagnosing Brucella PJI. Loose implants should be managed with revision surgery, while stable implants may be treated initially with antibiotics alone or combined with debridement.
