Brucellosis as a Cause of Septic Loosening of Total
M. Ortega-Andreu, MD, E. C. Rodriguez-Merchan, MD, PhD,
and M. Aguera-Gavalda, MD
Abstract: Infection after a total hip arthroplastyis a severe complication and is
associated with a high incidence of morbidity. We describe a case of late infection, 5
years after the implantation of a cemented hip prosthesis. The infection was caused
bygram-negative Brucella melitensis and occurred in a 63-year-old man who owned
cattle. As far as we know, such a complication has never been published before. Key
words: brucellosis, total hip arthroplasty, loosening, revision arthroplasty.
Deep late infection after total hip arthroplasty
(THA) is the second commonest cause of revision
THA . According to the Swedish National Regis-
try, 148,349 primary THAs were performed, and
11,198 eventuallywere revised for varying reasons,
with 8.2% of men and 7.2% of women requiring a
revision THA because of late infection . At the
Mayo Clinic in Rochester, Minnesota, 30,680 pri-
maryhip prostheses were implanted between 1969
and 1996 with 1.3% becoming infected .
Manyfactors are associated with late deep infec-
tion. Some of these factors relate to the immuno-
logic status of the patient, including diabetes, rheu-
matoid arthritis, obesity, malnutrition, urinary
infections, and therapywith corticosteroids. Other
factors are related to the infecting organism; gram-
negative organisms are more aggressive . We
present a deep late infection of a hip caused by
gram-negative Brucella melitensis in an owner of
A 63-year-old male cattle owner was admitted
because of right hip pain of 7 years’ duration. Pain
was increasing progressivelyand limiting hip mo-
bility, especially internal rotation. A ﬁxed ﬂexion
contracture of the hip was present. The medical
historyrevealed that the patient was a heavy
smoker and that he had been operated on because
of nodules of the vocal cords 10 years previously.
There was no historyof allergic reactions or infec-
tious diseases. After radiologic examination, the
patient was diagnosed with osteoarthrosis of the
A cemented CharnleyTHA was recommended
(DePuy, Warsaw, IN). Preoperative blood analysis
was normal and included leukocyte count, red
blood cell count, erythrocyte sedimentation rate,
biochemistry, urine analysis, blood coagulation,
chest radiograph, and electrocardiogram. Because
the patient was to be a bone bank donor (cryopre-
served femoral heads), the following preoperative
From the Service of Traumatology and Orthopaedic Surgery, La Paz
University Hospital, Madrid, Spain.
Submitted February9, 2001; accepted September 6, 2001.
No beneﬁts or funds were received in support of this study.
Reprint requests: E. C. Rodriguez-Merchan, MD, PhD, Capi-
tan Blanco Argibay21-G-3A, 28029-Madrid, Spain.
Copyright 2002, Elsevier Science (USA). All rights reserved.
The Journal of Arthroplasty Vol. 17 No. 3 2002