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Swai HF, Moledina SM, Nsato SB, Mgunya A, Rugemalila J, Byemelwa V, Ismail S, Chale P, Mwapule L, Masao A, Tarimo J, Meda A, Muhali F, Shoo M, Uiso E, Rwezaura S, Minja E, Beda D, Nyagabona SK, Kisanga O, Salehe S, Chiwanga F, Mwemba S, Rwegasha J, Shayo G. Diagnostic delay in ankle and foot tuberculosis resulting in tuberculoma and tuberculous meningitis in a middle-aged female: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241274223. [PMID: 39165302 PMCID: PMC11334117 DOI: 10.1177/2050313x241274223] [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: 03/27/2024] [Accepted: 06/21/2024] [Indexed: 08/22/2024] Open
Abstract
A middle-aged woman presents with chronic foot arthritis which progressed to a non-healing ulcer, which was unresponsive to conventional antibiotics and debridement. She then developed cerebral manifestations and was empirically treated with antitubercular medications which led to healing of the ulcer. Unfortunately, delays in initiating treatment resulted in development of other extrapulmonary tuberculosis complications such as cerebral tuberculoma with tuberculous meningitis. She was subsequently diagnosed with neurocysticercosis which continued to worsen during her hospital stay. She eventually succumbed to her illness due to the complications and a possible nosocomial infection. This case highlights the challenges with diagnosis of uncommon presentations of common diseases in an endemic area, leading to diagnostic delays and development of serious complications.
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Affiliation(s)
- Hedwiga F Swai
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Sibtain M Moledina
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sylvia B Nsato
- Radiology Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Amina Mgunya
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Joan Rugemalila
- Radiology Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Veridiana Byemelwa
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Sharon Ismail
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Pauline Chale
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Luth Mwapule
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Alex Masao
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Jude Tarimo
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Amunga Meda
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Fatuma Muhali
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - May Shoo
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Eva Uiso
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Stella Rwezaura
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Eliaichi Minja
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Deogratius Beda
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Sarah K Nyagabona
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Onesmo Kisanga
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Sayan Salehe
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Faraja Chiwanga
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Said Mwemba
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - John Rwegasha
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Grace Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Reasoner KC, Fiske CT, Yu J, Thomson DB, Staub MB. Mycobacterium tuberculosis Ankle Arthritis and Subsequent Immune-Reconstitution Inflammatory Syndrome. Am J Med 2024:S0002-9343(24)00479-0. [PMID: 39074676 DOI: 10.1016/j.amjmed.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]
Affiliation(s)
- Kaitlyn C Reasoner
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tenn.
| | - Christina T Fiske
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tenn
| | - James Yu
- Tennessee Orthopaedic Alliance, Nashville
| | | | - Milner B Staub
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tenn; Infectious Diseases Section, Veteran Affairs Tennessee Valley Healthcare System, Nashville
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Malihy Z, Benaissa E, Ben Lahlou Y, Maleb A, Elouennass M. Osteoarticular tuberculosis of the ankle, a rare localization: a case report. Access Microbiol 2023; 5:000654.v3. [PMID: 37970090 PMCID: PMC10634493 DOI: 10.1099/acmi.0.000654.v3] [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: 06/21/2023] [Accepted: 10/10/2023] [Indexed: 11/17/2023] Open
Abstract
Tuberculosis poses a considerable public health problem in countries where the disease is endemic. Osteoarticular tuberculosis represents 3-5 % of all tuberculosis cases and 10-15 % of extra-pulmonary tuberculosis cases. Involvement of the foot and ankle is rarer. We report a case of osteoarticular tuberculosis of the ankle in a 71-year-old patient with type 2 diabetes and hypertension who presented to the trauma department of the Mohammed V Military Hospital with a painful swelling of the ankle. Standard X-rays and computed tomography scans of the ankle showed inflammatory involvement of the bone and joints. Antitubercular therapy was instituted. Given the context of endemicity, any atypical presentation of lingering bone lesions should raise the suspicion of an osteoarticular tuberculosis in order to ensure early therapeutic management.
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Affiliation(s)
- Zakaria Malihy
- Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Elmostafa Benaissa
- Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Yassine Ben Lahlou
- Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Adil Maleb
- Laboratory of Microbiology, Mohammed VI University Hospital/Faculty of Medicine and Pharmacy (University Mohammed the first), Oujda, Morocco
| | - Mostafa Elouennass
- Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
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Marais L, Nieuwoudt L, Nansook A, Menon A, Benito N. Tuberculous arthritis of native joints - a systematic review and European Bone and Joint Infection Society workgroup report. J Bone Jt Infect 2023; 8:189-207. [PMID: 37780528 PMCID: PMC10539782 DOI: 10.5194/jbji-8-189-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: The aim of this systematic review was to assess the existing published data on the diagnosis and management of tuberculosis (TB) arthritis involving native joints in adults aged 18 years and older. Methods: This study was performed in accordance with the guidelines provided in the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Results: The systematic review of the literature yielded 20 data sources involving 573 patients from nine countries. There was considerable variation amongst the studies in terms of the approach to diagnosis and management. The diagnosis was mostly made by microbiological tissue culture. Medical management involved a median of 12 months of anti-tubercular treatment (interquartile range, IQR, of 8-16; range of 4-18 months). The duration of preoperative treatment ranged from 2 to 12 weeks. Surgery was performed on 87 % of patients and varied from arthroscopic debridement to complete synovectomies combined with total joint arthroplasty. The mean follow-up time of all studies was 26 months (range of 3-112 months). Recurrence rates were reported in most studies, with an overall average recurrence rate of approximately 7.4 % (35 of 475 cases). Conclusions: The current literature on TB arthritis highlights the need for the establishment of standardized guidelines for the confirmation of the diagnosis. Further research is needed to define the optimal approach to medical and surgical treatment. The role of early debridement in active TB arthritis needs to be explored further. Specifically, comparative studies are required to address questions around the use of medical treatment alone vs. in combination with surgical intervention.
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Affiliation(s)
- Leonard C. Marais
- Department of Orthopaedic Surgery, School of Clinical Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Durban 4001, South Africa
| | - Luan Nieuwoudt
- Department of Orthopaedic Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Grey's Hospital, Townbush Road, Pietermaritzburg 3201, South Africa
| | - Adisha Nansook
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Avenue, Cape Town 7505, South Africa
| | - Aditya Menon
- Department of Orthopaedics, P. D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
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Khan MJ, Asif N, Aziz MH, Shaikh SAH, Siddiqui FB, Moizuddin K, Nuhmani S. Arthroscopic debridement of the ankle in synovitis. J Med Life 2023; 16:1235-1239. [PMID: 38024814 PMCID: PMC10652676 DOI: 10.25122/jml-2023-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/16/2023] [Indexed: 12/01/2023] Open
Abstract
Inflammation and hypertrophy of the ankle joint's synovial lining can occur due to various causes. Chronic pain and degenerative changes may be due to synovitis causing clinical manifestations through traction on the joint capsule. The failure of conservative treatment for at least six months indicates arthroscopic debridement, which can provide significant pain relief without the morbidity of extensive surgical exposures. This study was therefore conducted to establish the functional results of arthroscopic debridement of the ankle joint in synovitis. Fifteen patients with chronic ankle pain who had not responded to conservative treatment for approximately six months were included in the study. Arthroscopic debridement was performed using a shaver blade, followed by a postoperative ankle physiotherapy regimen. Patients were assessed preoperatively and postoperatively using the AOFAS, FADI, and VAS scores, with a mean follow-up period of 26 months. There was a significant improvement in the final clinical outcomes of the patients. The post-operative VAS score improved to 2.20±0.56 (2-4) (p-value=0.001), the AOFAS score was 86±8.25 (65-98) (p-value-0.001), and the FADI Score was 86.93±7.35(70-96) (p-value=0.001). Thirteen patients (86.67%) achieved outstanding or good results, while two had fair results, according to Meislin's criterion. One patient reported a superficial wound infection, which subsided with antibiotic therapy. The study findings indicate that arthroscopic ankle debridement is an efficient method to treat persistent ankle discomfort induced by synovitis, and it has a low postsurgical complications rate, quicker recovery, and less joint stiffness.
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Affiliation(s)
- Mohammad Jesan Khan
- Department of Orthopedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Naiyer Asif
- Department of Orthopedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohd Hadi Aziz
- Department of Orthopedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Siraj Ahmed Hasham Shaikh
- Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Faiza Banu Siddiqui
- Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Khwaja Moizuddin
- Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Yang L, Zuo J, Li L, Wang D, Yang X, Tang X. Treatment of Stage I-III Hip Joint Tuberculosis With Open Surgical Debridement and Hip Spica in Children: A Retrospective Study. J Pediatr Orthop 2022; 42:482-487. [PMID: 35941096 PMCID: PMC9470041 DOI: 10.1097/bpo.0000000000002227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to evaluate the outcome of surgical debridement combined with postoperative hip spica immobilization in the treatment of hip joint tuberculosis in children. METHODS This retrospective study enrolled 87 children with stage I to III hip joint tuberculosis treated surgically at our hospital from January 2010 to January 2016. All patients considering hip tuberculosis routinely received a 4-week conservative treatment first, including rest, protected weight-bearing, and 4-drugs antitubercular chemotherapy. Surgical debridement was indicated when there was no relief after this conservative protocol. Patients were divided into 2 groups according to the duration of hip spica immobilization after operation: group A (hip spica for 4 wk, 39 patients) and group B (hip spica for 6 wk, 48 patients). All patients were recommended partial weight-bearing for 7 days and then followed the same hip joint exercises program when spica was removed. Postoperative radiographs, hip dislocation or subluxation, and modified Harris hip score (MHHS) were assessed. All patients were followed up at least 5 years. RESULTS There were 87 patients enrolled in our study, including 34 females and 53 males, with a mean age of 7.2±2.8 years old (range: 2 to 14 y). No significant difference was observed between these 2 groups in baseline data. In group A, the mean MHHS improved from 52.1±14.7 before surgery to 87.8±8.3 at the final follow-up ( P <0.000). In group B, there was also a significant difference between the preoperative MHHS (52.7±9.4) and the final MHHS (88.6±6.5) ( P <0.000). Although there was no significant difference between these 2 groups in the final MHHS ( P =0.593), there were also no significant differences between these 2 groups in wound healing delay (3 in group A and 6 in group B, P =0.705) and pathologic subluxation (3 in group A and 1 in group B, P =0.467). The only difference between group A (79.2±8.5) and group B (75.5±7.5) was the early functional outcome assessed by using MHHS after 1 month of hip joint exercises ( P =0.032). CONCLUSIONS Surgical debridement combined with antitubercular chemotherapy is an effective treatment for stage I to III hip tuberculosis in children when there is no improvement after conservative treatment. Prolonged hip spica immobilization may not reduce the risk of hip subluxation after open surgical debridement but could lead to a delay in early functional recovery. Time of spica immobilization should be individualized and based on the surgeon's evaluation and the patient's condition.
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Affiliation(s)
- Lei Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University
| | - Jingjing Zuo
- Rehabilitation Medicine Centre, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Lang Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University
| | - Daoxi Wang
- Department of Pediatric Surgery, West China Hospital, Sichuan University
| | - Xiaodong Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University
| | - Xueyang Tang
- Department of Pediatric Surgery, West China Hospital, Sichuan University
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Ferreira JB, Maia N, Caetano JP, Fernandes D, Rodrigues M, Serrano S. Postpartum Ankle Pain: A Suspected Complex Regional Pain Syndrome or a Rare Cause of Septic Arthritis? Cureus 2021; 13:e19509. [PMID: 34912646 PMCID: PMC8664402 DOI: 10.7759/cureus.19509] [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] [Accepted: 11/12/2021] [Indexed: 11/05/2022] Open
Abstract
Ankle tuberculosis is a relatively rare condition and may develop after hematogenous dissemination from the pulmonary origin, particularly in cases of immunosuppression. Both pregnancy and delivery are relatively immunosuppressive states, and immune modulations during these periods can contribute to the pathogenesis of disseminated tuberculosis. A 26-year-old mother presented with severe, continuous, and debilitating pain in the left ankle, lasting for three months after delivery and associated with fever. Inspection demonstrated ankle swelling and redness, with a cold and cyanotic forefoot. Ankle radiograph and musculoskeletal ultrasound evaluation were obtained. Tibiotalar joint arthrocentesis revealed purulent liquid suggestive of septic arthritis and an emergent arthroscopic washout of the ankle was performed. The synovial mycobacterial culture was posteriorly positive and the diagnosis established was both pulmonary and osteoarticular tuberculosis. A comprehensive rehabilitation program was then implemented to achieve maximum functional gains. This report presents a rare case of ankle tuberculosis diagnosed in the postpartum period. Early evaluation, treatment, and adequate rehabilitation interventions can be crucial to promote functionality and enhance the quality of life.
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Affiliation(s)
| | - Nuno Maia
- Orthopaedics, Centro Hospitalar de Leiria, Leiria, PRT
| | | | | | | | - Simão Serrano
- Physical Medicine and Rehabilitation, Centro Hospitalar de Leiria, Leiria, PRT
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Guerra MG, Martins P, Cruz-Machado AR, Barreira SC, Vieira-Sousa E, Vitorino E, Romeu JC, Khmelinskii N. The Importance of Timely Diagnosing Tuberculous Arthritis: The Role of Ultrasound-Guided Biopsy. J Clin Rheumatol 2021; 27:S845-S846. [PMID: 32091455 DOI: 10.1097/rhu.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Emília Vitorino
- Serviço de Anatomia Patológica, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - José Carlos Romeu
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte
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Basnayake O, Mathangasinghe Y, Nihaj A, Pitagampalage R, Jayarajah U, Gunawardena K, Mendis H. Tuberculosis presenting as arthritis of the ankle: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211035574. [PMID: 34377485 PMCID: PMC8320545 DOI: 10.1177/2050313x211035574] [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: 05/03/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis presenting as monoarticular involvement in immunocompetent patients is rare. Here, we report a Sri Lankan patient presenting with ankle swelling due to tuberculosis with no other extrapulmonary or pulmonary involvement. Magnetic resonance imaging showed destruction of articular cartilage of the ankle joint with chronic inflammation of the subtalar joint. The diagnosis was confirmed by synovial tissue culture which was positive for Mycobacterium tuberculosis. The patient recovered uneventfully with anti-tuberculosis treatment. Therefore, a high degree of suspicion is necessary to diagnose extrapulmonary tuberculosis when patients are presenting with atypical monoarthritis.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ahamed Nihaj
- National Hospital of Sri Lanka, Colombo, Sri Lanka
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Early debridement improves outcome in managing ankle tuberculosis: a systematic review. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lui TH. Role of arthroscopy and endoscopy in management of tuberculosis of the foot and ankle. Foot (Edinb) 2021; 46:101754. [PMID: 33285493 DOI: 10.1016/j.foot.2020.101754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
Tuberculosis of the foot and ankle is rare but destructive. It can affect bones, joints and soft tissue and can mimic a wide range of acute and chronic infections or tumorous conditions. The primary treatment objectives for osteoarticular TB include curing the infection, limiting deformity, maintaining mobility, and reducing discomfort. Chemotherapy remains the mainstay of treatment in acute stage. Indications of surgery include biopsy and debridement in early stages to reduce the tuberculosis load and enable better penetration of anti-tuberculous drugs. Other reported indications for surgery in early stage of TB foot and ankle include resection of lesion not responding to chemotherapy and debridement of lesions close to the articular surface, as surgical debridement might halt progression and joint invasion, avoiding worsening of the prognosis. The success of arthroscopic treatment for infectious arthritis with decreased morbidity and postoperative pain makes arthroscopy an excellent alternative to open surgery. The advantages such as minor trauma, short hospitalization time and short post operative rehabilitation period as well as good cosmetic and therapeutic results should lead to a more frequent use of arthroscopy as early as possible as an adjuvant for the tuberculous joint. However, tuberculosis can involve any joints, bone and soft tissue (tendon) of the foot and ankle and surgeons should equip with various arthroscopic and endoscopic techniques in order to deal with the various situations of tuberculosis of the foot and ankle.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT Hong Kong SAR, China.
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Zhang C, Cao J, Yang L, Duan X. Surgical treatment for insertional Achilles tendinopathy and retrocalcaneal bursitis: more than 1 year of follow-up. J Int Med Res 2021; 49:300060521992959. [PMID: 33682490 PMCID: PMC7944541 DOI: 10.1177/0300060521992959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyse the imaging changes in bone marrow oedema of the calcaneal prominence, retrocalcaneal bursa and degenerative Achilles tendon after the surgical treatment of insertional Achilles tendinopathy (IAT). METHODS This retrospective study analysed patients with IAT and retrocalcaneal bursitis that were diagnosed based on their symptoms and radiographic and magnetic resonance imaging (MRI) examinations. For patients that had received 3 months of conservative treatment but still presented with symptoms, arthroscopic debridement of the retrocalcaneal bursa and resection of calcaneal prominence were undertaken. Patients with degeneration of the Achilles tendon underwent debridement of Achilles tendon calcification with an open incision. The last follow-up included radiographic and MRI imaging, Visual Analogue Scale (VAS) pain scores and American Orthopedic Foot and Ankle Society (AOFAS)-Ankle and Hindfoot scores. RESULTS Thirty patients were included (mean ± SD follow-up, 3.1 ± 0.5 years). The VAS pain and AOFAS-Ankle and Hindfoot scores were significantly improved after surgery. MRI showed that bone marrow oedema of the calcaneal prominence and the retrocalcaneal bursa was significantly reduced compared with preoperative values. There was no significant change in the high signal area of the IAT. CONCLUSION Surgical treatment of IAT and retrocalcaneal bursitis effectively alleviated local pain and restored function.
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Affiliation(s)
- Changgui Zhang
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jin Cao
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaojun Duan
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Endoscopic Treatment of Symptomatic Foot and Ankle Bone Cyst with 3D Printing Application. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8323658. [PMID: 33426066 PMCID: PMC7781683 DOI: 10.1155/2020/8323658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022]
Abstract
Objective To study the efficacy of arthroscopy for treating symptomatic bone cysts of the foot and ankle through the follow-up of patients and to further explore the application value of 3D printing technology in this treatment. Methods Twenty-one patients with symptomatic bone cysts in the foot and ankle who underwent arthroscopic surgery in our Center from March 2010 to December 2018 were enrolled, including 11 in the experimental group and 10 in the control group. For the control group, C-arm fluoroscopy was used intraoperatively to confirm the positioning of the cysts; for the experimental group, a 3D model of the lesion tissue and the 3D-printed individualized guides were prepared to assist the positioning of the cysts. Debridement of the lesion tissues was conducted under an arthroscope. Regular follow-ups were conducted. The time of establishing arthroscopic approaches and the times of intraoperative fluoroscopy between the two groups were compared. Significance was determined as P < 0.05. Results The postoperative pathology of the patients confirmed the diagnosis. No significant perioperative complications were observed in either group, and no recurrence of bone cysts was seen at the last follow-up. The VAS scores and AOFAS scores of the two groups at the last follow-up were significantly improved compared with the preoperative data, but there was no statistical difference between the two groups. All surgeries were performed by the same senior surgeon. The time taken to establish the arthroscopic approaches between the two groups was statistically significant (P < 0.001), and the times of intraoperative fluoroscopy required to establish the approach were also statistically significant (P < 0.001). The intraoperative bleeding between the two groups was statistically significant (P < 0.01). There was 1 case in each group whose postoperative CT showed insufficient bone grafting, but no increase in cavity volume was observed during the follow-up. Conclusion With the assistance of the 3D printing technology for treating symptomatic bone cysts of the ankle and foot, the surgeon can design the operation preoperatively and perform the rehearsal, which would make it easier to establish the arthroscopic approach, better understand the anatomy, and make the operation smoother. This trial is registered with http://www.clinicaltrials.govNCT03152916.
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He Y, Liu J, Wang Z, Zhou P, Deng X, Yang L, Chen Z, Li Z. Analysis of the early clinical outcomes of arthroscopic debridement in the treatment of shoulder tuberculosis. J Orthop Surg Res 2020; 15:550. [PMID: 33218347 PMCID: PMC7678300 DOI: 10.1186/s13018-020-02086-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Due to atypical clinical symptoms, it is difficult to diagnose joint tuberculosis infection, which often results in misdiagnosis and missed diagnosis. It is easy to cause joint disability. And there are few reports of using arthroscopy to diagnose and treat shoulder tuberculosis. This case series aims to introduce the clinical outcomes of arthroscopic treatment of shoulder tuberculosis. Methods Twenty-nine patients with shoulder tuberculosis from September 2013 to February 2019 were included (10 males, 19 females; age range from 22 to 69; the average age is 37.6 years). All patients underwent arthroscopic lesion debridement, with preoperative and postoperative regular use of isoniazid, rifampicin, pyrazinamide, and streptomycin quadruple anti-tuberculosis drugs. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded before and at the last follow-up. The shoulder function was evaluated according to the visual analogue scoring method (visual analogue scale, VAS) pain score and Constant score. Results Twenty-nine patients were followed up from 12 months to 2 years, and the average follow-up time was 15.7 months. The pathological diagnosis of all patients after surgery was shoulder tuberculosis. No serious complications were found at the last follow-up, and the incision healed well. VAS pain score, Constant score, ESR, and CRP at the last follow-up were significantly improved compared with those before treatment (P < 0.05). Conclusion On the basis of the standard use of anti-tuberculosis drugs before and after surgery, shoulder arthroscopy is used to treat early and mid-term shoulder tuberculosis, which can be diagnosed by direct observation under the arthroscope and postoperative pathological examination. It has the advantages of thorough lesion removal, minimal invasiveness, rapid recovery, and reliable clinical effect.
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Affiliation(s)
- Yanwei He
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zhi Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Xiangtian Deng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.,School of Medicine, Nankai University, Tian Jin, People's Republic of China
| | - Li Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.,Department of Hematology, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zan Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.
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