Brucella periprosthetic joint infection: epidemiology, precision diagnosis, and management-a comprehensive review and proposed clinical framework.

OBJECTIVES

To describe diagnostic delay and treatment burden in Brucella periprosthetic joint infection (PJI) and propose a stratified evidence-informed clinical framework.

METHODS

We comprehensively reviewed published cases of Brucella PJI and summarized data from 80 patients to describe epidemiology, clinical features, diagnosis, treatment, and reported outcomes.

RESULTS

Of 80 patients, 59.72% were not diagnosed before initial treatment. Low culture yield and failure to meet conventional PJI criteria appeared to contribute to delayed recognition. Fifty-five percent received ≥3 treatment courses, and 55.30% had a total treatment duration ≥4.5 months, often in the context of misdiagnosis and staged revision surgery. Combining exposure history with serology and molecular diagnostics may facilitate diagnostic recognition. Antimicrobial therapy, with or without drainage, may be appropriate for stable prostheses, whereas one-stage revision plus antibiotics was associated with shorter hospitalization and potentially lower treatment burden in loosened prostheses.

CONCLUSION

Based on observational data predominantly from case reports, we propose an evidence-informed framework incorporating multi-modal diagnostics and individualized surgical strategies that may improve recognition and outcomes while potentially reducing treatment burden in Brucella PJI. Validation in prospective studies is required.