Tuberculous Arthritis of the Knee Treated with Two-Stage Total Knee Arthroplasty

Abstract

It has been estimated that 2 billion people worldwide currently have tuberculosis in its latent form and that the active form of the disease will develop in 8 million people annually1. Tuberculous arthritis of the knee is one of the most common musculoskeletal manifestations2-6. While chemotherapy remains the cornerstone of treatment7, surgery of the knee may also be indicated and has been reported to include debridement and synovectomy8-10, arthrodesis11-14, amputation15-18, resection arthroplasty19-23, and prosthetic joint replacement24. Recently, there have been several reports of successful management of tuberculous arthritis of the knee with primary total knee arthroplasty25-31. Most of the world's experience in managing musculoskeletal tuberculosis is reported from outside of the United States. Yet, the prevalence of this disease in the United States is substantial and, according to recent data, may be on the rise32. To raise awareness and improve management of this disease, we report the case of a patient with advanced, active, and refractory tuberculous arthritis of the knee with extensive joint destruction. Our patient was managed with medical therapy and a two-stage surgical approach that was designed to sterilize the joint and permit successful total knee arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and he consented. A sixty-two-year-old native-born Filipino man, 167 cm tall and weighing 77 kg, presented in January 2004, with symptoms of fever and a productive cough of several weeks' duration. The patient had immigrated to the United States in 1955 and had become a U.S. citizen, but he still frequently visited the Philippines. After a positive Mantoux skin test, further workup included chest …