[Our experience with total knee arthroplasty following tuberculous arthritis (1980-2005)]

Orthopedic tuberculosis is number one in non-pulmonary forms of tuberculosis and, among these, knee joint tuberculosis ranks second after spinal tuberculosis. Arthritic lesions are currently treated by total knee arthroplasty (TKA).

A group of 10 patients who, after having gone through tuberculous gonarthritis, underwent TKA was evaluated for the period from 1980 to 2005. It consisted of six women and four men, whose average age at the time of arthroplasty was 65 years.

The most frequent indication for TKA after tuberculous gonarthritis was post-inflammatory arthritis (80 %); the other indication was fibrous ankylosis (20 %). No conversion of arthrodesis to total replacement was carried in our group. All patients underwent pre-operative microbiological tests including PCR, as well as histological examination. Pre- and post-operative prophylaxis included anti-tuberculous (AT) drugs (rifampicin and izoniazid) combined with a cephalosporin antibiotic. AT drugs were administered for 3 to 5 months after surgery in accordance with the results of laboratory tests.

In 1980 to 2005, ten patients after tuberculous gonarthrosis underwent TKA at our department. No complications were recorded. The average range of flexion was 0 to 90 degrees. None of the patients needed any walking aid, and all were able of full weight-bearing on the treated limb. There was no recurrent tuberculosis in this group.

Any implantation of an endoprosthesis in a post-inflammatory terrain is always difficult. Subjective evaluation by the patients was good. At long-term follow-up, clinical, radiographic and laboratory findings were within standards, which is in agreement with the results of other authors. The pre- and post-operative therapy with AT drugs and antibiotics was used in all patients.

Compared to arthrodesis, TKA brings about a significant improvement in the patient's mobility as well as a better quality of life. Before the patient is indicated for TKA, emphasis is placed on recording a thorough medical history, complete laboratory examination, radiography, CT scans, or magnetic resonance imaging, relevant orthopedic, internal and pulmonary examination including X-ray of the heart and lungs, as well as the assessment of the patient's somatic and psychical state with regard to the post-operative rehabilitation course.