Abstract:

Objective: To investigate the clinical efficacy of one-stage radical debridement combined with total knee arthroplasty (TKA) on the basis of standard anti-tuberculosis treatment for advanced knee tuberculosis. Methods: A retrospective analysis was performed on the clinical data of 21 patients with advanced knee tuberculosis admitted to The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region from January to December 2014. All patients received one-stage radical debridement combined with TKA and anti-tuberculosis chemotherapy. Perioperative laboratory indicators including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were collected. Pain and functional outcomes, including Hospital for Special Surgery (HSS) knee score, knee range of motion (ROM), and visual analogue scale (VAS) score, were documented before surgery and at the last follow-up. Prosthesis stability and postoperative complications were also recorded. Changes in CRP, ESR levels, HSS score, ROM and VAS score were compared between preoperative and postoperative status to evaluate the improvement of knee pain and function. Results: All patients underwent uneventful surgery with primary wound healing. The mean operative time was (100.5±12.3) min, the mean postoperative hospital stay was (11.5±2.2) d, and the mean duration of postoperative anti-tuberculosis chemotherapy was (14.0±2.6) months. All patients were followed up for 6 to 36 months, with a median follow-up of 24 (24, 36) months. At the last follow-up, the median (interquartile range, IQR) CRP was 5.4 (4.1, 6.8) mg/L and ESR was 14 (12, 17) mm/1 h, which were significantly lower than the preoperative levels (median (IQR) CRP: 15.8 (11.5, 20.3) mg/L; median (IQR) ESR: 45 (31, 67) mm/1 h), with statistically significant differences (χ²=91.575 and 86.941, respectively; both P<0.001). During follow-up, 1 patient (4.8%) developed wound breakdown due to early self-discontinuation of medication, and achieved full recovery after adjustment of the anti-tuberculosis regimen and debridement. At the last follow-up, all remaining patients had well-positioned prostheses, with no complications such as prosthesis loosening or periprosthetic fracture. Preoperatively, the mean HSS score was 39.0±7.0, the median (IQR) ROM was 60 (45, 75)°, and the mean VAS score was 6.7±0.9. At the last follow-up, the mean HSS score reached 81.3±6.8, the median (IQR) ROM was 100 (95, 110)°, and the mean VAS score was 2.1±0.7. Knee pain and function were significantly improved, with all differences statistically significant (t=51.421, P<0.01; Wilcoxon signed-rank test, P<0.01; t=24.500, P<0.01). Conclusion: For advanced knee tuberculosis, on the premise of strictly selecting indications, implementing standardized perioperative anti-tuberculosis treatment and performing thorough intraoperative debridement, one-stage TKA can effectively control infection, relieve pain and reconstruct knee function with a low recurrence rate. It is a feasible therapeutic strategy.

Key words: Tuberculosis, osteoarticular, Arthroplasty, replacement, knee, Treatment outcome, Evaluation studies as topic