Sauer B, Hofmann G O, Tiemann A
Fachkrankenhaus für Orthopädie, Waldkrankenhaus Bad Düben.
Z Orthop Unfall. 2009 Nov-Dec;147(6):734-9. doi: 10.1055/s-0029-1185895. Epub 2009 Aug 20.
With this manuscript we want to show a means of the clinical management in an advanced stage of tuberculous destruction of the knee in elderly, polymorbid patients with a high risk of undergoing surgery.
We describe the case of a patient who suffered from a Mycobacterium bovis infection of the left knee that led to spontaneous ankylosis in her childhood. At the age of 87 years an acute exacerbation of the tuberculous osteoarthritis occurred due to a drop attack with a fracture in the region of the previous knee ankylosis. Considering the patient's age and general poor condition, it was our paramount goal to preserve her walking ability and to avoid that she becomes bedridden.
After radical surgical debridement and resection of the ankylosis, we achieved macroscopically clean bone and soft tissue conditions. We performed palliative arthrodesis with a long intramedullary nail and a cement spacer. Additionally, the patient underwent a tuberculostatic therapy for 8 months. The acute inflammatory process could be stopped and the ability of the patient to walk could be preserved.
Because of the increased incidence of tuberculosis in the industrialised countries during the past 20 years, it should be considered as a differential diagnosis in cases of unclear septic arthritis.
