A 10-Year Systematic Review of Brucella Periprosthetic Joint Infections Following Total Knee Arthroplasty.

Abstract

Background: Brucella species are zoonotic pathogens responsible for brucellosis, a systemic bacterial infection primarily transmitted through direct contact with infected animals or consumption of unpasteurized dairy products. While Brucella infections following total knee arthroplasty (TKA) are rare, they pose significant diagnostic and therapeutic challenges with limited reported cases.

Methods: A systematic review, following the Preferred Reporting in Systematic Reviews and Meta-Analyses guidelines, was performed on February 22, 2025, using the databases PubMed and Google Scholar for Brucella TKA periprosthetic joint infections (PJIs) in patients older than 18 years. The search was further narrowed by excluding articles before 2015 to reflect the most current trends and practices. Our eligibility criteria were guided by the Population, Intervention, Comparison, and Outcome framework. We considered outcomes including, but not limited to, successful eradication of infection, complications, and functional outcomes following intervention.

Results: Fifteen studies met inclusion criteria. Brucella PJIs in a TKA typically present late with nonspecific symptoms, often mimicking aseptic loosening or culture-negative PJIs. Most patients had identifiable risk factors, including travel to endemic regions, animal exposure, or consumption of unpasteurized dairy. Two-stage revision was used in 11 of 15 cases. Conservative management with implant retention was successful when no loosening was present in 3 out of the 15 cases. The most common antibiotic treatment was doxycycline plus rifampicin with duration ranging from 3 to 12 months, most commonly for a total of 6 months. Successful outcomes are possible with prolonged combination antibiotics and often require 2-stage revision arthroplasty, though diagnostic and treatment approaches vary widely.

Conclusion: This is an updated systematic review of Brucella infections following TKA within the last 10 years. Given the insidious onset and potential for chronic infection, orthopaedic surgeons and infectious disease specialists must be aware of the possibility of Brucella PJIs in patients with the appropriate history and clinical examination.

Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.