Total knee arthroplasty in fused knees is technically demanding and has a considerable complication rate, this paper reported good results of three cases of patients who had undergone total knee arthoplasty following previous arthrodesis due to tuberculosis infection.
Tuberculosis of the appendicular skeleton is an uncommon infection by tubercle bacili, TBC shows a preponderence tothe spine (40%), then the hip (25%), and finally the knee (8%). The common presenting symptoms as gradual onset, pain, stiffness, limp, swelling, and local heat. Radiographs demonstratechanges only after three to four weeks of infection, and initially soft tissue swelling may be the predominant feature. The classic triad of radiological findings, known asthe Phemister triadare seen, which include juxta-articular osteopenia, joint space narrowing, and erosions. Laboratory investigations may yield the classical, although nonspecific findings of raised ESR, a leukocytosis, and high C-reactive protein. Histological patterns in tissue specimens will show a central necrotic area surrounded by histiocytes and occasional giant cells with nuclei positioned at the margin of the cell. Options for treatment once the diagnosis is confirmed must involve antituberculous chemotherapy often requiring twelve to eighteen months of chemotherapy (isoniazid, rifampicin, pyrazinimide, and ethambutol). Surgery options include debridement, synovectomy, arthrodesis, amputation, and success has been shown with primary joint arthroplasty may be indicated to improve symptoms and quality of life inpatients affected by joint infection.
Case : We reported six cases patient tuberculosis of knee had undergone arthrodesis with plate and screws of her left knee joint due to tuberculous arthritis 2 to 8 years before presentation, 3 years after arthrodesis procedure the plate and screws was removed. Five cases were women and 1 men with the youngest 22 yo and the oldest 60 yo, the mean age of 35, 16 years. Then primary TKA for 3 cases was performed via a medial parapatellar incision to follow the previous incision scar by using PS designs. The clinical and radiological evaluations were done considering the knee range of motion and Knee Society Score (KSS).
Result: The mean KSS knee score were improved from 50.33 ± 11.60 to 90.06 ± 3.07 (P < 0.001). The mean range of motion were improved from 0° (fusion knees) pre-operation to 116.61 ± 16.29° post-operation (P < 0.001), ESR and CRP laboratory back to the normal after 6 month follow-up. Case one 5 years, case two 2 years, case three 1 year and the others 3 cases still with arthrodesis waiting for TKA.
When former knee arthrodesis prepared properly and the next step was primary Total Knee Arthroplasty, then primary Total Knee Arthroplasty (TKA) can give good results with the use of a standar PS design.
Keywords : Arthrodesis, Total knee arthroplasty, Tuberculosis knee joint