关键词: 结核, 骨关节, 膝关节, 关节强直, 关节成形术, 置换, 膝, 治疗结果

Abstract:

Objective To explore the clinical feasibility of total knee resurface arthroplasty (TKR) in treatment of the patients with tuberculous knee joint stiffness.Methods A retrospective analysis was used. A total of 10 cases with tuberculous knee joint stiffness, who hospitalized at our hospital from October 2011 to July 2015 and were treated with TKR, were enrolled into this study. Before the operation of TKR, a comprehensive assessment was given to each patient, including the function of the knee joint and the situation of tuberculosis (TB) disease. The laboratory examinations, magnetic resonance imaging (MRI) of knee joint, X-ray and CT scan, as well as the correct anti-TB chemotherapy were given to the patients. The total knee resurface arthroplasty was performed to the patients whose knee joint TB had been well controlled, bone defects did not influence the stability of joint prostheses and had no sinus tract and mixed infections. After the operation, the correct anti-TB chemotherapy was continued, and the joint prosthesis stability, the knee joint functions (Hospital for Special Surgery Knee Score (HSS) was used), the range of motion and the relapse of knee joint TB were evaluated.Results Before the operation, among 10 patients, 3 cases had rigidity knee while 7 cases had stiff knee; 4 cases had active knee joint TB with the disease course of 4-9 months, and the remaining 6 patients had old lesions of knee joint TB with the disease course of 20-41 month. All patients were followed up till 24-41 months after surgery, and the average follow-up time was (35.4±9.6) months. The time of operation ranged from 90 minutes to 118 minutes, and the average time was (102.0±8.5) minutes. The preoperative knee joint stiffness angle of the patients ranged from 15.0° to 55.0°; at the end of follow-up, the flexion angle of the patients’ knee ranged from 95.0°to 120.0°(mean (105.0±14.8)°) and the extensor angle ranged from -5.0°to 10.0°(mean (0.5±7.0)°). The score of HSS had improved from 46.6±16.2 before the operation to 79.6±9.6 after the operation. At the end of follow-up, no loosening of joint prostheses and no relapse of TB were found.Conclusion Under the premise of individual and correct anti-TB chemotherapy, the clinical treatment to the patients with tuberculous knee joint stiffness by using total knee resurface arthroplasty is effective and feasible. However, the surgical indications should be strictly assessed and followed.

Key words: Tuberculosis, osteoarticular, Knee joint, Ankylosis, Arthroplasty, replacement, knee, Treatment outcome