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Nizar A, Misbah I, Purushothaman R, Rajabalaji V, Ashraf M, Balasubramanian N. A Systematic Review and Qualitative Analysis of Studies Performing Total Knee Arthroplasty (TKA) in Tuberculosis (TB) of the Knee. Cureus 2024; 16:e57964. [PMID: 38738119 PMCID: PMC11086042 DOI: 10.7759/cureus.57964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
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.
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Affiliation(s)
- Abin Nizar
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Iffath Misbah
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Raja Purushothaman
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Vasudevan Rajabalaji
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Munis Ashraf
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Navin Balasubramanian
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
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Pinto I, Marques V, Dias L. Tuberculosis Presenting as Chronic Monoarthritis: A Case Study. Cureus 2023; 15:e39430. [PMID: 37378114 PMCID: PMC10292089 DOI: 10.7759/cureus.39430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Mycobacterium tuberculosis infection remains a common disease in developing countries with the potential to involve the osteoarticular system. The authors report a case of knee arthritis due to tuberculosis (TB) in a 34-year-old woman. The patient presented with pain and swelling of the right knee as major complaints, without a history of respiratory symptoms. Magnetic resonance imaging (MRI) demonstrated a marked joint effusion, involving synovial tissue with cartilaginous lesion compatible with pigmented villonodular synovitis (PVNS). After several physiotherapy courses without significant relief, total knee arthroplasty was proposed. Two months after surgery and rehabilitation, symptoms did not completely resolve, with limited active range of motion. Microbial bone biopsy culture at the time of the arthroplasty revealed a TB infection. Due to the rarity and clinical nonspecificity of TB bone manifestations, early diagnosis may be challenging. Yet, attempted diagnosis and prompt pharmacological intervention are paramount to improve outcomes.
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Affiliation(s)
- Irene Pinto
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Vilma Marques
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Lúcia Dias
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT
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Van Le T, Duong TB, Hien KQ, Ton QNQ, Huyn T, Binh TP, Tu DT, Tho PP, Binh LN, Hau HP, Hung TNK. Two-stage revision for treatment of tuberculous prosthetic hip infection: an outcome analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:645-651. [PMID: 35778623 DOI: 10.1007/s00590-022-03317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Prosthetic joint infections (PJI) and especially tuberculosis (TB) PJI are rare diseases and hard to cure. The effectiveness of treatments for tuberculous PJI still remains a problem. The objective of this research was to indicate the success of two-stage revision replacement and also giving the associated criteria. METHODS From 2015 to 2020, five patients with tuberculous PJI were treated with two-stage revision at Cho Ray hospital, Vietnam. We collected the dataset which included demographic data, the interval from the time of joint replacement to reported infection, records of tuberculous PJI, administration of anti-TB medications (duration, months), history of operation(s), duration of follow-up, and specific type(s) of antibiotics loaded in bone cement. The approval for this study was made by the institutional review board from Cho Ray Hospital, Vietnam. We conducted a literature review based on the keywords "PJI" and "TB" on PubMed. RESULTS Five patients [median age 66 years (range 35-84)] had found tuberculous PJI. The median time from arthroplasty to diagnosis was 19 months (range 4-48). The diagnosis was confirmed by joint aspirates or synovial tissue. Positive PCR was also reported in all cases. The average duration of anti-tuberculosis polytherapy administration was 14.4 months. The operative techniques on five patients included debridement and using spacer loaded with 2 g streptomycin (and 2 g vancomycin if they got a coinfection) for 1 pack of bone cement, and revision arthroplasty. In most cases, the outcome of treatment using two-stage revision replacement was 80%. Overall, the auxiliary bacterial infections were recognized in three patients with tuberculous PJI and Staphylococcus aureus. Streptomycin and vancomycin were loaded in a cement spacer to increase the success rate, and tuberculous PJI was controlled for all patients. CONCLUSION Tuberculous PJI can be controlled with two-stage revision replacement with an antibiotic-loaded cement spacer that is molded intraoperatively with custom mold and prolonged anti-tuberculosis treatment in all cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tuan Van Le
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Tran Binh Duong
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Kha Quang Hien
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | | | - Tan Huyn
- Faculty of Pharmacy, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Tran Phuoc Binh
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Dao Thanh Tu
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Pham Phuoc Tho
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Le Nguyen Binh
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Huynh Phuoc Hau
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Truong Nguyen Khanh Hung
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam.
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
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Samade R, Voskuil RT, Scharschmidt TJ. Two-stage TKA for tuberculosis septic arthritis of the knee masquerading as pigmented villonodular synovitis: A case report. Knee 2022; 38:30-35. [PMID: 35872480 DOI: 10.1016/j.knee.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 05/31/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
A 25-year-old female presented with left knee pain following arthroscopic synovectomy for presumed pigmented villonodular synovitis (PVNS). Radiographs and magnetic resonance imaging demonstrated tricompartmental arthritic changes. She underwent a two-stage procedure first involving antibiotic spacer implantation, followed 1 week later by spacer removal and definitive total knee arthroplasty (TKA) once initial intraoperative culture results were negative. Subsequent cultures confirmed tuberculosis septic arthritis. Repeat evaluation 1 year postoperatively showed no complications and patient satisfaction with left knee function. This is a unique case report in the United States describing 1-year outcomes following staged TKA for tuberculosis septic arthritis masquerading as PVNS.
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Affiliation(s)
- Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Ryan T Voskuil
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Thomas J Scharschmidt
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
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Zendeoui A, Oueslati A, Tounsi A, Saadi S, Znagui T, Nouisri L. Knee tuberculosis: A misleading clinical entity (case report). Int J Surg Case Rep 2022; 96:107236. [PMID: 35716624 PMCID: PMC9207542 DOI: 10.1016/j.ijscr.2022.107236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Bone and joint infections are rare localizations of tuberculosis, and its diagnosis is challenging. The atypical clinical presentation may lead to delayed diagnosis and severe complications. CASE PRESENTATION We report the case of a 72-year-old female diagnosed with tuberculosis of the knee. She was complaining of progressive right knee pain and swelling without systemic signs. She was misdiagnosed as having a flare-up of osteoarthritis, which led to a delayed diagnosis and a septic subluxation of the knee. We performed a knee arthrotomy, lavage, and stabilization with an external fixator. The microbiologic tests did not isolate any germs. However, a histological examination confirmed the diagnosis by revealing a caseating granuloma surrounded by epithelioid cells. The patient treated with anti-tuberculosis therapy had a good evolution. Three months post-surgery, the external fixator was replaced with a removable knee brace. DISCUSSION Osteoarticular tuberculosis is often caused by the hematogenous route. The lack of specificity in clinical and radiological signs makes the diagnosis difficult, especially at the early stage, leading to delays in diagnosis and complications. Nevertheless, the recognition of predisposing factors to tuberculosis, with persisting symptoms despite treatment, should draw the intention of further investigation. The treatment of osteoarticular tuberculosis is primary medical with antituberculosis chemotherapy. However, surgical treatment is reserved for specific indications and mostly to treat complications. CONCLUSION The lack of specificity in clinical and radiological signs in osteoarticular tuberculosis may mislead the physician. Nevertheless, focusing on predisposing factors, especially in endemic areas, may guide diagnosis and avoid complications.
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Affiliation(s)
- Ahmed Zendeoui
- Orthopaedic department, Military hospital of instruction-Tunis, Tunisia,Corresponding author.
| | - Achraf Oueslati
- Orthopaedic department, Military hospital of instruction-Tunis, Tunisia
| | - Ahmed Tounsi
- Orthopaedic department, Military hospital of Gabes, Tunisia
| | - Saber Saadi
- Orthopaedic department, Military hospital of instruction-Tunis, Tunisia
| | - Talel Znagui
- Orthopaedic department, Military hospital of instruction-Tunis, Tunisia
| | - Lotfi Nouisri
- Orthopaedic department, Military hospital of instruction-Tunis, Tunisia
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