Tuberculosis of the knee: A pitfalls in clinical settings (A case report and literature review)

A Case of Complex Deformity of Knee Corrected by Ilizarov Fixation in a Teenage Patient

Introduction

After the spine, the knee is the second most common location for skeletal tuberculosis. An unusual complication of tuberculosis infection is triple knee deformity. The combination of knee flexion, posterolateral tibial subluxation, and external tibial rotation over femoral condyles manifests as a severe deformity. Currently, a variety of surgical intervention techniques are recommended for knee deformity correction, including the use of an Ilizarov ring fixator or limb reconstruction system, total knee arthroplasty, and arthrodesis with synovectomy.

Case Report

A 17-year-old adolescent with a 2-year limping history and left knee flexion deformity and swelling was examined. The patient was treated with anti-tuberculosis therapy for 9 months after being diagnosed as having pulmonary tuberculosis. The results of the left knee synovial fluid aspiration revealed confirmation of tuberculosis knee. The Ilizarov technique was used to treat the patient's 95° fixed flexion deformity of the knee which was associated with painful jog of movements.

Conclusion

The Ilizarov procedure has been regarded as the best way to treat complicated deformities of the knee caused by tuberculosis sequelae because it has great clinical results and few side effects.

A Systematic Review and Qualitative Analysis of Studies Performing Total Knee Arthroplasty (TKA) in Tuberculosis (TB) of the Knee

Tuberculosis (TB) is a widespread global disease that significantly impacts daily life. Skeletal TB comprises about 10-35% of all TB cases. Significant research on the spine and hip exists, but due to the rarity of cases, the management of TB is less explored. Furthermore, exercising the option of total knee arthroplasty (TKA) in TB knees is still in its initial stages. This systematic review aims to identify and comprehend the difficulties associated with diagnosing TB-affected knees, their treatment outcomes, and complications related to TKA. A systematic review of existing English literature retrieved from PubMed, Google Scholar, and Web of Science databases was performed using the PRISMA guidelines. A case series of arthroplasty performed on TB knees included a description of the diagnostic approach, clinical outcome, and complication rates. Moreover, studies involving case series with follow-up functional outcomes were included. The Coleman Methodology was used to assess the quality of the studies. A total of six studies (75 knees) were systematically reviewed in this study. The diagnosis of TB knee is multimodal, with MRI being a reliable tool. Administering anti-TB chemotherapy is essential during the perioperative period. Regarding recurrence, a two-stage TKA has a lower risk of recurrence. It is plausible to state that anti-TB chemotherapy needs to be initiated in the perioperative period to prevent the chances of recurrences. Two-stage TKA is reserved for patients who require soft tissue debridement despite adequate chemotherapy.

99mTc-Ethambutol Scan with SPECT/CT in Knee Joint Tuberculosis

Modalities for in vivo imaging of Mycobacterium tuberculosis are limited and inadequately studied. One such modality is 99mTc-ethambutol scintigraphy which has shown promising results for diagnosis of tuberculosis (TB). Ethambutol, one of the primary antitubercular drugs, is bacteriostatic which acts on the mycolic acid cell wall synthesis of the M. tuberculosis. However, literature on its utility is scarce. The few studies that exist have reported its sensitivity and specificity between 90%- 95% and 71%-85%. We present here a case demonstrating the role of 99mTc-ethambutol scan in knee joint TB.

Tuberculosis of the knee masquerading as pigmented villonodular synovitis: Report of two cases

Introduction and importance

The manifestation of tuberculous mimicry is challenging to diagnose, especially in extrapulmonary Tuberculosis (TB). Pigmented villonodular synovitis (PVNS) may mimic tuberculous arthritis of the knee joint. In young, otherwise healthy-appearing individuals, tuberculous arthritis and PVNS in the knee joint could present as monoarticular involvement, with painful swelling of extended duration and limited movement. The core therapies for tuberculous arthritis and PVNS are different.

Case presentation

There are two patients. First, male 25 years old presented with a painful mass at the left knee of 3-years duration. The second patient was 14 years old boy who presented with a painful mass at his left knee for ten months before being admitted to the hospital. From the physical examination, plain x-ray, and MRI, both patients are highly suggestive of PVNS. However, the histopathology result and microbial culture showed a tuberculous-specific process.

Clinical discussion

Because of its clinical manifestations, X-ray, and MRI features, patients were initially suspected of having the diffuse type of PVNS. An improper diagnosis may be due to atypical clinical presentation, wide use of antibiotics, the low specificity of diagnostic tools, and most of all, the clinician not prioritizing the possibility of tuberculous arthritis. Open biopsy and the result of the microbial culture establish the definitive diagnosis of knee tuberculosis.

Conclusion

In conclusion, the clinical and radiologic findings in TB gonitis and PVNS are occasionally similar. Therefore TB gonitis should be highly suspicious, especially in endemic areas. Histopathology results and mycobacterial culture need to determine the diagnosis.

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Tuberculosis of the knee may mimic pigmented villonodular synovitis.

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Tuberculosis of the knee must be considered in diagnosing PVNS.

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Histopathological and culture results are essential in diagnosing knee tuberculosis