Mycobacterial periprosthetic joint infection of the hip and knee: current concepts in diagnosis and management.

Authors

Carolina Coelho Cunha, Ghazal Pourbozorg, Atthakorn Jarusriwanna, Katherine Balden, Mauro José Salles, Javad Parvizi

Published in

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. Aug 21, 2026. Epub Aug 21, 2026.

Abstract

Mycobacterial periprosthetic joint infection (PJI) of the hip and knee is rare and difficult to diagnose and treat. This narrative review summarizes current evidence on the epidemiology, microbiology, diagnosis, surgical management, antimicrobial therapy, and outcomes of PJI caused by Mycobacterium tuberculosis complex (MTB) and nontuberculous mycobacteria (NTM).
We synthesized evidence from clinical studies, systematic reviews, consensus documents, and relevant case series addressing hip and knee mycobacterial PJI. Evidence on epidemiology, diagnostic methods, surgical strategies, antimicrobial regimens, and outcomes was reviewed to derive practical clinical considerations.
Mycobacterial PJI should be suspected in culture-negative or indolent infection, failure of conventional antibacterial therapy, immunosuppression, or relevant tuberculosis exposure. Diagnosis requires appropriate specimens for prolonged mycobacterial culture, histopathology, molecular testing when available, and antimicrobial susceptibility testing. Management should integrate surgery with prolonged, species-directed multidrug therapy. Two-stage revision is the most frequently reported reconstructive strategy when reimplantation is feasible, but comparative evidence does not establish a universally superior operation. Debridement with implant retention may be considered only in carefully selected early infections, including selected rapidly growing mycobacterial infections. Regimens and treatment duration differ substantially between MTB and NTM.
Early recognition and accurate microbiological diagnosis are essential. Management requires multidisciplinary collaboration and individualized medical-surgical treatment. Because current recommendations derive mainly from retrospective studies and case series, multicenter studies using standardized diagnostic, therapeutic, functional, and outcome definitions are needed.

PMID:
42627466
Bibliographic data and abstract were imported from PubMed on 22 Aug 2026.

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