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Total Knee Arthroplasty in Advanced Active Tuberculous Arthritis of the Knee

Author(s): Jingsheng Wang, Tingting Liu, Apeng Zou, Qingpeng Shi, Baisui Zhou

Purpose

The purpose of this study was to evaluate the safety of total knee arthroplasty (TKA) in the patients with advanced active tuberculous arthritis of the knee.

Methods

Eight patients with advanced active tuberculous arthritis of the knee were reviewed in this study. The diagnosis of each patient was confirmed by intraoperative histopathology of the biopsy specimen revealing granulomatous lesions with epithelioid histiocytes surrounded by lymphocytes. Cemented TKA with primary prosthesis was performed in all patients. Patients were given post-operative antitubercular medications for a total of twelve months. Local symptoms, erythrocyte sedimentation rate (ESR) values, and radiographs were used for detecting the recurrence of tuberculosis. The hospital for special surgery knee score (HSS) system was used to evaluate the function outcomes of the involved knees.

Results

Within an average follow-up period of 48.8 months, no recurrence of tuberculous infection was found in any of the patients. The ESR became normal (< 20 mm/h) within six months after TKA in all patients. At the most recent follow-up, the average HSS score improved from 32.4 ± 8.6(18-42) points preoperatively to 85.6 ± 9.7(68-94) points (p<0.001). All knees showed good integrity and no evidence of loosening of the prostheses was found. Bacteriological examination was positive for four patients.

Conclusions

TKA for advanced active tuberculosis of the knee is a safe procedure providing symptomatic relief and functional improvement. A long infection-free interval is not a prerequisite for TKA. Wide surgical debridement and adequate post-operative antitubercular chemotherapy are the mainstay to eradicate the infection.

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