Sarvodaya Hospital Research Centre Sector 8, Sarvodaya Hospital Sector 19, Faridabad, Haryana, India.
Department of Orthopaedics. Sarvodaya Hospital Sector -8, Faridabad, Haryana, India.
Indian J Tuberc. 2024 Oct;71(4):460-464. doi: 10.1016/j.ijtb.2023.12.011. Epub 2023 Dec 28.
Extrapulmonary tuberculosis (EPTB) accounts for 16 % of tuberculosis cases globally, with knee joint tuberculosis more prevalent in underdeveloped nations. Total knee arthroplasty (TKA) is commonly used to treat tubercular arthritis of knee, however, there is a marked paucity of research on the outcomes after an incidental diagnosis. The aim of the study is to investigate the outcomes of total knee arthroplasty after an incidental diagnosis of tuberculosis and its management.
A prospective-observational study was conducted in NCR-Delhi from May 2019 to June 2023, wherein 533 patients had synovial tissue abnormalities and 11 patients reported with positive histopathological examination (HPE) for knee tuberculosis. All the patients whose informed consent was obtained were put on a twelve-month standard treatment (2HRZE or S/10HR) according to World Health Organization (WHO) guidelines for extrapulmonary TB after TKA and were monitored for the outcome of treatment, any postoperative complication, or implant failure.
The mean age of the patients was 63 ± 13 years and 72.7 % of patients were female. The mean hemoglobin, Body Mass Index (BMI), and Erythrocyte Sedimentation Rate (ESR) values were 10.29 ± 1.36 mg/dl, 29.78 ± 6.1 kg/m, and 37.37 mm/h respectively and the median of the C-reactive protein (CRP) value was 11 mg/dl at the time of operative procedure. All patients presented with knee-joint pain and swelling and were operated for knee-joint replacement surgery. After one year of standard treatment (2HRZE or S/10HR), no relapses, pain, or progressive radiolucency around the component, or postoperative neurologic or vascular complications were observed. The median range of motion (ROM) was improved from 10 - to 100 to 0-115, the average knee score improved from 44.9 ± 8.9 to 84.9 ± 7.73 points and the average function score improved from 28.82 ± 15.56 to 94.0 ± 7.68 points which were statistically significant at 95 % CI (p < 0.0001).
We concluded from this study that any abnormalities in ESR, CRP level prior to, and bone tissue or synovial tissue during operative procedure should be considered for articular tuberculosis and managed according to guidelines. This will make replacement procedures more sustainable and effective by lowering the risk of post-operative infection or implant-related complications and improving patients' quality of life.
全球范围内，肺外结核（EPTB）占结核病病例的 16%，膝关节结核在欠发达国家更为普遍。全膝关节置换术（TKA）常用于治疗膝关节结核性关节炎，但对于偶然诊断后的治疗效果，相关研究明显不足。本研究旨在探讨偶然诊断为结核后的全膝关节置换术的治疗效果。
本前瞻性观察性研究于 2019 年 5 月至 2023 年 6 月在 NCR-Delhi 进行，其中 533 例患者存在滑膜组织异常，11 例患者膝关节结核的组织病理学检查（HPE）呈阳性。所有获得知情同意的患者均按照世界卫生组织（WHO）关于肺外结核的指南，在 TKA 后接受为期 12 个月的标准治疗（2HRZE 或 S/10HR），并监测治疗结果、任何术后并发症或植入物失败情况。
患者的平均年龄为 63±13 岁，72.7%为女性。平均血红蛋白、体重指数（BMI）和红细胞沉降率（ESR）值分别为 10.29±1.36mg/dl、29.78±6.1kg/m 和 37.37mm/h，C 反应蛋白（CRP）的中位数为 11mg/dl，在手术时。所有患者均表现为膝关节疼痛和肿胀，并接受膝关节置换手术。经过 1 年的标准治疗（2HRZE 或 S/10HR）后，未出现复发、疼痛、关节周围组件进行性透光、术后神经或血管并发症。中位关节活动度（ROM）从 10°-100°改善至 0°-115°，平均膝关节评分从 44.9±8.9 分提高至 84.9±7.73 分，平均功能评分从 28.82±15.56 分提高至 94.0±7.68 分，差异均有统计学意义（95%CI，p<0.0001）。
我们从这项研究中得出结论，术前 ESR、CRP 水平以及术中骨组织或滑膜组织的任何异常均应考虑为关节结核，并根据指南进行治疗。这将通过降低术后感染或植入物相关并发症的风险，提高患者的生活质量，使置换手术更具可持续性和效果。
