The Curative Effect Analysis Of The Therapy Of One-stage Focal Debridement And TKA For Late Active Tuberculosis Of Adults Knee

ObjectiveTo observe the clinical effect and feasibility of one-stage focal debridement and total knee arthroplasty(Total Knee Arthroplasty,TKA)in the treatment of adult advanced active total knee tuberculosis.MethodsFrom January 2012 to March 2018,32 cases(32 knees)of adult patients with advanced active total knee tuberculosis underwent one-stage total knee arthroplasty in the orthopaedic joint group of our hospital.32 patients were selected in strict accordance with the inclusion criteria and exclusion criteria(see the main text for more details),including 14 males and 18 females.At the time of operation,the age was 39.78±11.82 years(24-69 years).Preoperative knee joint pain with rest pain,swelling with limited activity,erythrocyte sedimentation rate and hypersensitive C-reactive protein were significantly higher than normal values.The patients were treated with tetra-antituberculosis drugs for 4 weeks or more.After the operation,erythrocyte sedimentation rate and hypersensitive C-reactive protein were significantly decreased or close to normal.At this time,complete focal debridement and total knee arthroplasty in stage I were performed.We divided the inner part of knee joint into 6 areas,the I-VI region being the suprapatellar bursa,respectively.Internal test of inter-sulcus,lateral sulcus,subpatellar fat pad,tibial plateau and surrounding,posterior articular capsule,debridement was carried out according to the area by region,to avoid omitting lesions as far as possible,at least two or more of the lesions were selected for pathological examination.From the second day after the operation,the original quad antituberculosis treatment was at least 12 months and 18 months after the operation.It must be ESR,high-sensitivity C-reactive protein(CRP)reduced to normal level,and maintained.At least 6 months,Fang consider stopping medication.The knee function was evaluated by(American knee society knee score,AKS(American knee Association score)system.The quality of life before and after operation was evaluated with SF-36 scale.After 3,6,12 months and every year of follow-up,the knee X-ray films were re-examined.ESR,CRP,recorded the ESR,CRP,AKS function score and SF-36 scale score of the patients at admission and postoperative follow-up.Using SPSS 23.0 statistical software package to process data and measure data Using paired t-test,the data were described by mean ±standard deviation.Compared with the follow-up results before operation,the difference was statistically significant(P<0.05).ResultsThe postoperative pathological examination supported the diagnosis of tuberculosis infection in 32 patients with grade A wound healing,no pain of redness and swelling,disappearance of tuberculosis poisoning symptoms,and deep venous thrombosis of lower limbs in 4 patients.After anticoagulation treatment,thrombus was eliminated and discharged.14 cases(14 knees)with mild swelling of the affected lower limbs were treated with symptomatic treatment,physiotherapy and raising the affected limbs,and the swelling was eliminated.All 32 cases(32 knees)were followed up for 38.31±17.17 months(12-84 months).Follow-up X-ray showed that there was no transparent line around the knee prosthesis,indicating that there was no sign of loosening,and the prosthesis was stable at the same time.There were no signs of recurrence of tuberculosis.At admission,ESR was(43.16±9.21)mm/h,CRP and(43.64±12.78)mg/L,AKS knee joint score before operation(26.56±7.01);At the last follow-up,ESR was(3.88±1.60)mm/h,CRP and(3.12±1.64)mg/L,AKS knee function score(90.31±4.90).There was significant difference between pre-and post-operative follow-up(P<0.05).SF-36 score of pre-operation and 12-month follow-up The differences were statistically significant(P<0.05).ConclusionsTotal knee arthroplasty(total knee arthroplast,TKA)can be used for tuberculosis infection of the knee.On the premise that anti-tuberculosis therapy is effective before operation and continues to adhere to anti-tuberculosis treatment after operation,the focus should be completely removed according to the area by area of the knee joint during the operation.Stage I focal debridement total knee arthroplasty for adult advanced active total knee tuberculosis can achieve good results.Postoperative tuberculosis recurrence rate is low,prosthesis survival rate is high,is a safe and feasible treatment.