Total knee arthroplasty in tuberculous arthritis.

Sixteen cases of tuberculosis of the knee treated by total knee arthroplasty with followup of 3.4 to 11 years were reviewed. Eight cases were treated with antituberculous chemotherapy for 2 to 20 months before and 1 year after the arthroplasty. Another 8 cases were not diagnosed primarily and therefore received only postoperative antituberculous chemotherapy. Five cases had a recurrence of tuberculosis. Four of these 5 cases did not receive preoperative antituberculous treatment. The infection in 1 case was controlled satisfactorily with chemotherapy alone, and for the other 3 cases, chemotherapy was supported by surgical debridements. The last case of recurrent infection occurred in a patient who had received long- standing corticosteroid therapy. He required an excisional arthroplasty to control the infection. The mean functional knee score was 30.5 points before surgery and 82.6 points at the time of the last followup. These results suggest that arthroplasty may be formed for knees badly damaged with tuberculous infection, and good results may be expected for those patients who have received effective antituberculous chemotherapy both before and after surgery. There is a substantial risk of reactivation of tuberculous infection for those patients not treated before surgery or for patients dependent on corticosteroids.