Reumatologia: pesquisas atuais
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Unusual Presentation of Tuberculous Arthritis Diagnosed after Total Knee Replacement

Jaffer M, Opondo E

Introduction: The use of TKA to treat active joint tuberculosis remains controversial and most orthopedic surgeons would advise against it in cases with active tuberculosis (TB). Skeletal tuberculosis is an uncommon infection that accounts for approximately 2% of all musculoskeletal tuberculosis.

Methods: This case reported is of a 36 years old male diagnosed to have knee tuberculosis after suffering with progressive symptomatic arthropathy for 4 years with multiple attempts to detect extrapulmonary TB found negative. He then had a TKA which histopathologically confirmed the through only a positive ZN stain on the synovial tissue. This treatment has led to a reduction in pain, excellent range of motion and no reactivation of TB. He had initially been diagnosed to have pillonodularsynovitis on two biopsies and treatment geared toward the same was not successful in alleviating symptoms.

Results: The good result of intervention in this patient despite the duration of symptoms and the infective cause can be attributed to the biological behavior of Mycobacterium tuberculosis and its reaction to implant as compared to other bacterial infections such as Staphylococcus aureus.

Conclusion: The diagnosis of knee Tuberculosis can be challenging especially in patients with no obvious pulmonary disease and discharging sinuses. ZN staining was able to detect the TB when the microscopy for Acid Fast Bacilli could not. Active TB diagnosed after TKA has been reported in several small series with good outcomes after systemic chemotherapy. The clinical outcomes of TKA in patients diagnosed with TB post-surgery compare favorably with those of non-infected knees.