Abstract
Background
Controversies regarding the treatment of advanced tuberculosis of the knee still exist. We retrospectively investigated protocols of total knee arthroplasty (TKA) and their efficacy in patients with advanced tuberculosis.
Methods
Nine TKAs associated with advanced tuberculosis were performed at our institution between 2008 and 2013, with a mean follow-up of 4.4 years (range 2–7 years). In four cases with elevated inflammatory biomarkers, patients received three months of antitubercular drug treatment followed by two-stage TKA. In the remaining five cases with normal biomarkers, patients received one-stage TKA with no pre-operative drug therapy. All patients received antitubercular therapy for one year post-operatively. Clinical and radiological data during follow-up were gathered to evaluate the effects of treatment.
Results
There was no tuberculosis reactivation and all cases demonstrated marked improvement in function and favorable states of prostheses. Specifically, the mean Hospital for Special Surgery (HSS) knee score increased from 44.8 (range 30–60) preoperatively to 82.7 (range 64–92) at last follow-up (P < 0.05). The average range of motion was 56° (range 10° to 90°) before surgery and 94° (range 80-110) at final follow-up (P < 0.05). Elevated erythrocyte sedimentation rates (ESR) and C-reactive protein (CRP) levels returned to normal in a mean of 4.0 months (range 3–5 months) and 3.9 months (range 3–6 months) post-operatively, respectively.
Conclusion
Although a consensus of views regarding surgical timing, prosthesis selection, and peri-operative antitubercular therapy has not been reached, our results suggest that TKA can be performed for advanced tuberculous arthritis.
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References
Zumla A, George A, Sharma V, Herbert RH, Baroness Masham I, Oxley A et al (2015) The WHO 2014 global tuberculosis report--further to go. Lancet Glob Health 3(1):e10–e12
Marschall J, Evison JM, Droz S, Studer UC, Zimmerli S (2008) Disseminated tuberculosis following total knee arthroplasty in an HIV patient. Infection 36(3):274–278
Sanghvi DA, Iyer VR, Deshmukh T, Hoskote SS (2009) MRI features of tuberculosis of the knee. Skelet Radiol 38(3):267–273
Wolfgang GL (1985) Tuberculosis joint infection following total knee arthroplasty. Clin Orthop Relat Res 201:162–166
Watts HG, Lifeso RM (1996) Tuberculosis of bones and joints. J Bone Joint Surg Am 78(2):288–298
Tuli SM (2002) General principles of osteoarticular tuberculosis. Clin Orthop Relat Res 398:11–19
Bae DK, Yoon KH, Kim HS, Song SJ (2005) Total knee arthroplasty in stiff knees after previous infection. J Bone Joint Surg (Br) 87(3):333–336
Lim HC, Bae JH, Hur CR, Oh JK, Han SH (2009) Arthrodesis of the knee using cannulated screws. J Bone Joint Surg (Br) 91(2):180–184
Eskola A, Santavirta S, Konttinen YT, Tallroth K, Lindholm ST (1988) Arthroplasty for old tuberculosis of the knee. J Bone Joint Surg (Br) 70(5):767–769
Kim YH (1988) Total knee arthroplasty for tuberculous arthritis. J Bone Joint Surg Am 70(9):1322–1330
Su JY, Huang TL, Lin SY (1996) Total knee arthroplasty in tuberculous arthritis. Clin Orthop Relat Res 323:181–187
Habaxi KK, Wang L, Miao XG, Alimasi WQ, Zhao XB, Su JG et al (2014) Total knee arthroplasty treatment of active tuberculosis of the knee: a review of 10 cases. Eur Rev Med Pharmacol Sci 18(23):3587–3592
Ozturkmen Y, Uzumcugil O, Karamehmetoglu M, Leblebici C, Caniklioglu M (2014) Total knee arthroplasty for the management of joint destruction in tuberculous arthritis. Knee Surg Sports Traumatol Arthrosc 22(5):1076–1083
Zeng M, Hu Y, Leng Y, Xie J, Wang L, Li M, Zhu J (2015) Cementless total hip arthroplasty in advanced tuberculosis of the hip. Int Orthop 39(11):2103–2107
Gale DW, Harding ML (1991) Total knee arthroplasty in the presence of active tuberculosis. J Bone Joint Surg (Br) 73(6):1006–1007
de Haan J, Vreeling AW, van Hellemondt GG (2008) Reactivation of ancient joint tuberculosis of the knee following total knee arthroplasty after 61 years: a case report. Knee 15(4):336–338
Leclere LE, Sechriest VF 2nd, Holley KG, Tsukayama DT (2009) Tuberculous arthritis of the knee treated with two-stage total knee arthroplasty. A case report. J Bone Joint Surg Am 91(1):186–191
Harwin SF, Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS et al (2013) Tubercular prosthetic knee joint infection. Orthopedics 36(11):e1464–e1469
Tekin Koruk S, Sipahioglu S, Calisir C (2013) Periprosthetic tuberculosis of the knee joint treated with antituberculosis drugs: a case report. Acta Orthop Traumatol Turc 47(6):440–443
Tokumoto JI, Follansbee SE, Jacobs RA (1995) Prosthetic joint infection due to Mycobacterium tuberculosis: report of three cases. Clin Infect Dis 21(1):134–136
Marmor M, Parnes N, Dekel S (2004) Tuberculosis infection complicating total knee arthroplasty: report of 3 cases and review of the literature. J Arthroplasty 19(3):397–400
Lee CL, Wei YS, Ho YJ, Lee CH (2009) Postoperative Mycobacterium tuberculosis infection after total knee arthroplasty. Knee 16(1):87–89
Wang Y, Wang J, Xu Z, Li Y, Wang H (2010) Total hip arthroplasty for active tuberculosis of the hip. Int Orthop 34(8):1111–1114
Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (Phila Pa 1976) 30(1):38–43
Hardinge K, Cleary J, Charnley J (1979) Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg (Br) 61-B(2):144–147
Eskola A, Santavirta S, Konttinen YT, Tallroth K, Hoikka V, Lindholm ST (1988) Cementless total replacement for old tuberculosis of the hip. J Bone Joint Surg (Br) 70(4):603–606
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Zeng, M., Xie, J., Wang, L. et al. Total knee arthroplasty in advanced tuberculous arthritis of the knee. International Orthopaedics (SICOT) 40, 1433–1439 (2016). https://doi.org/10.1007/s00264-015-3050-x
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DOI: https://doi.org/10.1007/s00264-015-3050-x