Jing Zhu and Xin Tang contributed equally to this work.
The authors declare that they have no competing interests.
TX and ZJ carried out the background literature research and the follow-up evaluations for all patients. TX and ZJ equally contributed to the writing of the paper. LQ and CG were responsible for analysis and interpretation of the data. LJ and FW initiated the study, provided suggestions for the study and critically reviewed the manuscript. LJ was the senior author was responsible for the study set-up. All authors read and approved the final manuscript.
The treatment of end-stage tuberculosis (TB) of the knee remains a significant clinical challenge, and clinical data are lacking. This study aimed to retrospectively determine the outcome of single-stage knee arthrodesis with a unilateral external fixator combined with cannulated screws for the treatment of end-stage TB.
Twenty-six patients with end-stage knee TB were treated by single-stage arthrodesis. All patients underwent open debridement and the insertion of a unilateral external fixator combined with crossed cannulated screws and received systemic antitubercular therapy. Clinical evaluations and radiographic analyses were performed after an average follow-up duration of 5.5 years.
The mean time to radiographic bone fusion was 5.6 months. Primary full union was achieved in 25 patients (96.2 %) within 8 months, and the remaining patients achieved bone fusion at 14 months postoperatively. The mean post-operative alignment was 5.4° valgus and 12.5° flexion. The mean leg-length discrepancy was 2.8 cm. The mean VAS score improved from 67.3 before surgery to 16.2 at the last follow-up (P < 0.01), and the mean WOMAC score improved from 58.8 to 13.7 (P < 0.01). The erythrocyte sedimentation rate (ESR) and C-reactive protein level returned to normal in 25 patients by 3 months postoperatively. No recurrence in the target knee was noted.
Single-stage arthrodesis with a unilateral external fixator combined with cannulated screws can be regarded as efficacious for the treatment of end-stage knee TB. Additional studies are necessary to confirm the findings of our study.
Global tuberculosis control. WHO report 2011. Geneva: World Health Organization; 2011.
Watts HG, Lifeso RM. Tuberculosis of bones and joints. J Bone Joint Surg Am. 1996;78:288–98. PubMed
Pasion EG, Leung JP. TB Arthritis. Curr Orthop. 2000;14:197–204. CrossRef
Erdem H, Baylan O, Simsek I, Dinc A, Pay S, Kocaoglu M. Delayed diagnosis oftuberculous arthritis. Jpn J Infect Dis. 2005;58:373–5. PubMed
Conway JD, Mont MA, Bezwada HP. Arthrodesis of the knee. J Bone Joint Surg Am. 2004;86:835–48. PubMed
Nichols SJ, Landon GC, Tullos HS. Arthrodesis with dual plates after failed total knee arthroplasty. J Bone Joint Surg Am. 1991;73-A:1020–4.
Bellamy N. WOMAC osteoarthritis index—a user’s guide. Canada: London Health Sciences Centre, London; 1995.
Brumback RJ, Uwagie-Ero S, Lakatos RP, Poka A, Bathon GH, Burgess AR. Intramedullary nailing of femoral shaft fractures. Part II: fracture-healing with static interlocking fixation. J Bone Joint Surg Am. 1988;70:1453–62. PubMed
Oostenbroek HJ, van Roermund PM. Arthrodesis of the knee after an infected arthroplasty using the Ilizarov method. J Bone Joint Surg Br. 2001;83-B:50–4. CrossRef
Munzinger U, Knessl J, Gschwend N. Arthrodesis following knee arthroplasty. Orthopade. 1987;16:301–9. PubMed
Hak DJ, Lieberman JR, Finerman GA. Single plane and biplane external fixators for knee arthrodesis. Clin Orthop. 1995;316:134–44. PubMed
Gale DW, Hading ML. Total knee arthroplasty in the presence of active tuberculosis. J Bone Joint Surg Br. 1991;73:1006–7. PubMed
Kim YH. Total knee arthroplasty for tuberculous arthritis. J Bone Joint Surg Br. 1998;70:1322–30.
- Knee arthrodesis using a unilateral external fixator combined with crossed cannulated screws for the treatment of end-stage tuberculosis of the knee
- BioMed Central
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