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General: R. Trebse, V. Pisot, and A. Trampuz Treatment of infected retained implants J Bone Joint Surg Br 2005; 87-B: 249-256 [Abstract] [Full text] [PDF]

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Immune status of patients and diagnostic difficulties in infected implants

Anil Agarwal M.S. (Ortho.), Rachna Agarwal   (19 May 2005)

Immune status of patients and diagnostic difficulties in infected implants 19 May 2005
Anil Agarwal M.S. (Ortho.), CONSULTANT ORTHOPAEDICIAN , Rachna Agarwal Send letter to journal: Re: Immune status of patients and diagnostic difficulties in infected implants rachna_anila{at}yahoo.co.in Anil Agarwal M.S. (Ortho.), et al.	Sir, We enjoyed reading this article. Several participants in the study were elderly and might have been suffering from multiple chronic ailments (e.g. diabetes); others were rheumatoid and might have been taking immuno-suppressive drugs or steroids. The immune response to infection may be decreased or altered if the person is not immuno-competent. Therefore, the immuno-competency of the patients should also be addressed in the inclusion criteria. Furthermore, the aspiration criteria, used in the definition of an infected implant, may not always be suggestive of deep infection as infection confined to superficial planes can mimic a positive aspirate and thus a diagnostic dilemma always remains. The authors do not differentiate between the radiological criteria for implant stability in internal fixation devices and arthroplasties. Peri-prosthetic infection by Mycobacterium tuberculosis sometimes has a similar pattern as that described by Trebse et al in their article.1,2 We believe that in suspicious cases, tuberculosis should always be included in the differential diagnosis. A. AGARWAL R. AGARWAL Delhi, India. 1. Spinner RJ, Sexton DJ, Goldner RD, Levin LS. Periprosthetic infections due to Mycobacterium tuberculosis in patients with no prior history of tuberculosis. J Arthroplasty 1996;11:217-22. 2. Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Osmon DR. Prosthetic joint infection due to Mycobacterium tuberculosis: a case series and review of the literature. Am J Orthop 1998;27:219-27.