Total knee arthroplasty in advanced tuberculous arthritis of the knee

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.

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.

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.

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.