Abstract
BackgroundWith the global determination to eliminate tuberculosis (TB), the treatment for end-stage TB of the knee joint is still a great clinical challenge. This study aims to retrospectively determine the clinical and radiographic outcomes after use of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage knee TB.MethodsTwenty-six patients with end-stage knee TB treated by external fixation with the Ilizarov fixator between 2012 and 2017 were examined. Anti-TB drugs were administered preoperatively, intraoperatively, and postoperatively. Clinical and radiologic examinations were performed for comprehensive evaluations, and these include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), flexion and valgus angle of the knee, leg-length discrepancy, and Lysholm score.ResultsTwenty-four patients were followed up for an average of 5.8 years (2.2–7 years). All patients achieved bone fusion within a mean of 6.4 months (4–16 months). The ESR and CRP concentrations were observed to return to normal within 5.1 ± 1.1 months postoperatively. There was no recurrence of TB. At last follow-up, the mean leg-length discrepancy was 2.7 ± 1.4 cm, and the mean alignment was 8.7 ± 2.6° flexion and 5.3 ± 1.0° valgus. No patient had a significant rotational deformity. The average Lysholm score was seen to improve significantly from 36.8 ± 18.4 preoperatively to 79.5 ± 5.9 at final follow-up (p < 0.0001).ConclusionThis study has demonstrated that the Ilizarov technique for knee joint arthrodesis as a treatment of end-stage knee TB achieved promising outcomes with minimal complications.
Highlights
With the global determination to eliminate tuberculosis (TB), the treatment for end-stage TB of the knee joint is still a great clinical challenge
This study has demonstrated that the Ilizarov technique for knee joint arthrodesis as a treatment of end-stage knee TB achieved promising outcomes with minimal complications
The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) concentrations for all patients were higher than normal, and our findings revealed that these patients had not previously received continuous standard anti-TB treatment
Summary
With the global determination to eliminate tuberculosis (TB), the treatment for end-stage TB of the knee joint is still a great clinical challenge. Because of the difficulty of early diagnosis and the relatively low level of economic and transportation resources in some areas, many patients with TB of the knee are often referred for medical treatment late in the disease course or when it is already terminal [8]. The Ilizarov technique, characterized by the tension–stress principle, has been widely used in orthopedic treatment of lower limb fractures, bone defects, and ankle diseases [11,12,13] This approach can be used to treat knee joints with total knee arthroplasty failure, osteoarthritis, or septic knee as a method for joint fusion [14,15,16]. This technique for the treatment of end-stage TB of the knee has only been reported in a case report, without detailed surgical procedure and long-term follow-up [17]
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