Mid-term Follow-up Of One-stage Joint Replacement In Advanced Active Tuberculosis Of The Knee

Objective: To discuss the feasibility of one-stage joint replacement in advanced active tuberculosis of the knee.Methods: from March 2009 to March 2019,15 cases of advanced active tuberculosis of knee joint were treated by one-stage knee joint replacement in the orthopedic center of Xinjiang Uygur Autonomous Region People's Hospital,including 5 males(6 knees),10 females(10 knees),with an average age of 53.9 years(26-77 years).All patients had knee joint pain at the time of admission,and the knee joint was deformed and restricted in different degrees,four cases had ankylosis of knee joint.C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were higher than the normal value.X-ray and CT showed that the joint space was narrow,and bone destruction was found at the joint edge.MRI showed synovial hyperplasia and edema of the knee joint,,abscess formation,and 7 chest X-ray films showed old tuberculosis.The HSS score of knee joint was 43.4 ± 9.4,and ROM was 49.3° ± 31.3 °.Regular antituberculosis treatment was performed for 1-2 weeks before operation.After continuous reduction of CRP and ESR,one-stage joint replacement were performed.After operation,regular follow-up was conducted to find out whether there was recurrence of tuberculosis,knee joint function and prosthesis stability.Results: cementrd prosthesis was used during the operation.Typical tuberculous granuloma was found in 12 cases and acid fast staining was positive in 3 cases.15 cases were followed up for 12-88 months.Regular anti tuberculosis treatment was performed for 12-18 months.During the follow-up period,1 cases of tuberculosis recurred and were cured by debridement.In the last follow-up,there was no recurrence of tuberculosis and no loosening of prosthesis on X-ray.The score of HSS was 82.7 ± 7.5 and ROM was 86.0° ± 32.5°(P < 0.05).Conclusion: under the premise of regular antituberculous treatment before and after operation and thorough focus removal during operation,one-stage joint replacement can control infection,relieve pain and reconstruct knee joint function,and the recurrence rate is low in mid-term follow-up.The long-term effect still need to be observed and studied.