Hai-li Shen1, Yayi Xia, Peng Li, Jing Wang, Hua Han. 1. Institute of Orthopaedics, The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, People's Republic of China.
Abstract
INTRODUCTION: Due to atypical clinical presentation, wide use of antibiotics and lack of specificity in diagnosis, misdiagnosis is common, and diagnosis of tubercular infection in a joint is increasingly difficult. The use of arthroscopy for the diagnosis and treatment of early-stage knee TB has rarely been reported. Through this case series we describe the usefulness of arthroscopy for the management of synovial tuberculosis of the knee joint. MATERIALS AND METHODS: Synovectomy and synovial membrane biopsy were performed using arthroscopy in ten subjects suffering from synovial tuberculosis. This was combined with intra-articular isoniazid injection and systemic antituberculosis drugs. RESULTS: In all cases, continuous passive motion exercise was started 2 days after operation and they were followed up from 6 months to 3 years. The flexion angles 90 degrees +/- 5 degrees preoperatively increased to 120 degrees +/- 14 degrees in nine patients following surgery, the extension limit angle also improved from an average 20 degrees +/- 3 degrees preoperatively to 5 degrees +/- 1 degrees postoperatively. There was a significant difference in knee function index between preoperation and postoperation (t = 6.9, t = 6.3, P < 0.01). Japanese Institute of Plastic Surgery synovial disease treatment success criteria was also improved from 44.4 +/- 8.4 points before surgery to 81.5 +/- 10.4 following surgery (t = 8.749, P < 0.01). The joint swelling disappeared or was relieved after 2 months. No relapse of tuberculosis was found at the time of follow-up. CONCLUSION: Combined use of arthroscopy and antituberculosis medication appears to be advantageous for the management of early-stage synovial tuberculosis of the knee joint. Arthroscopic removal of the pannus allows better nutrition of the cartilage and thus greatly improves the joint function.
INTRODUCTION: Due to atypical clinical presentation, wide use of antibiotics and lack of specificity in diagnosis, misdiagnosis is common, and diagnosis of tubercular infection in a joint is increasingly difficult. The use of arthroscopy for the diagnosis and treatment of early-stage knee TB has rarely been reported. Through this case series we describe the usefulness of arthroscopy for the management of synovial tuberculosis of the knee joint. MATERIALS AND METHODS: Synovectomy and synovial membrane biopsy were performed using arthroscopy in ten subjects suffering from synovial tuberculosis. This was combined with intra-articularisoniazid injection and systemic antituberculosis drugs. RESULTS: In all cases, continuous passive motion exercise was started 2 days after operation and they were followed up from 6 months to 3 years. The flexion angles 90 degrees +/- 5 degrees preoperatively increased to 120 degrees +/- 14 degrees in nine patients following surgery, the extension limit angle also improved from an average 20 degrees +/- 3 degrees preoperatively to 5 degrees +/- 1 degrees postoperatively. There was a significant difference in knee function index between preoperation and postoperation (t = 6.9, t = 6.3, P < 0.01). Japanese Institute of Plastic Surgery synovial disease treatment success criteria was also improved from 44.4 +/- 8.4 points before surgery to 81.5 +/- 10.4 following surgery (t = 8.749, P < 0.01). The joint swelling disappeared or was relieved after 2 months. No relapse of tuberculosis was found at the time of follow-up. CONCLUSION: Combined use of arthroscopy and antituberculosis medication appears to be advantageous for the management of early-stage synovial tuberculosis of the knee joint. Arthroscopic removal of the pannus allows better nutrition of the cartilage and thus greatly improves the joint function.