Total Knee Arthroplasty for Tuberculous Arthritis

Nineteen patients (twenty-two knees) who had tuberculous arthritis of the knee had a total knee arthroplasty. The interval between the subsidence of signs of infection and the arthroplasty ranged from three months to five years, and the period of follow-up ranged from twenty-four to forty-nine months. Culture of fluid that had been aspirated from the joint preoperatively and culture of a biopsy specimen were negative. Biopsies of specimens of synovial material revealed tuberculous granuloma in all patients, despite negative findings for acid-fast organisms. The prosthesis was implanted with cement in four knees and without cement in eighteen. The mean functional rating was 39 points preoperatively and 83 points at the time of final follow-up. No component loosened. One patient had an arthrodesis because of recurrent active tuberculous infection. Two other patients had recurrence of the infection, which was controlled satisfactorily in one by chemotherapy alone and in the other by chemotherapy and débridement of a sinus tract, without removal of the prosthesis.