Clinical study of two-stage total knee arthroplasty in the treatment of advanced complex and severely active tuberculosis of the knee

Abstract Objective： To investigate the feasibility and efficacy of one-stage debridement and two-stage total knee arthroplasty in the treatment of advanced complicated and severely active tuberculosis of the knee joint. Methods: A retrospective analysis was performed on the clinical data of 12 patients who underwent two stages of artificial knee replacement for advanced severely active tuberculosis of the knee in the department of Osteoarthrosis of our hospital from January 2015 to December 2019. The average age was 50.5 years (21-71 years). All patients received lesion removal and perioperative anti-tuberculosis drug therapy. In the first phase, debridement was performed after at least 2 weeks of anti-tuberculosis chemotherapy to remove abscesses and infected necrotic tissue as thoroughly as possible, and SPACER was implanted in 7 cases, followed by at least 3 months of anti-tuberculosis chemotherapy (mean 5.4 months). In the second stage, if CRP and ESR were reduced to less than 2 times of the normal value and the wound healed well, artificial knee replacement was performed. Anti-tuberculosis chemotherapy was continued for 8-9 months after the operation, and the total anti-tuberculosis chemotherapy lasted 12-20 months. HSS knee score and range of motion, as well as prosthesis stability, ESR and CRP, and X-ray were evaluated. Results: All patients received 18-76 months of follow-up and 12-20 months of regular anti-tuberculosis treatment. No pulmonary tuberculosis recurrence or co-infection was found in all patients, and ESR and CRP were reduced to within 2 times of normal after several months. At the last follow-up, no recurrence of tuberculosis was found in all patients, and no loosening of prosthesis was found in X-ray examination. HSS score of knee increased from (41.42±10.47) points before surgery to (82.58±9.14) points, and ROM of knee increased from (40.42°±15.73°) to (100.83°±9.73°). There were statistically significant differences before and after operation (P<0.001). Conclusions: For advanced complicated and severely active tuberculosis of the knee, one-stage debridement and two-stage total knee arthroplasty can effectively control infection, relieve pain and reconstruct the function of the knee joint