Shinde Abhishek, Veerendra Andela
Department of Orthopaedics, MGM Medical College, Sambhajinagar, Maharashtra, India.
J Orthop Case Rep. 2025 Sep;15(9):188-193. doi: 10.13107/jocr.2025.v15.i09.6064.
Tuberculosis (TB) remains a significant global health challenge, with 10.6 million new cases and 1.3 million deaths reported in 2022. Extrapulmonary TB accounts for approximately 16% of all cases, with osteoarticular TB being a notable subset. Tubercular arthritis of the knee is a rare manifestation, often misdiagnosed due to its atypical presentation. Total knee arthroplasty (TKA) is considered the treatment of choice in advanced cases; however, evidence on outcomes in cases with incidental tubercular findings remains limited. This report highlights a case of tubercular arthritis of the knee diagnosed incidentally and evaluates the clinical outcomes following TKA.
A 55-year-old female patient of South Asian descent presented with progressive left knee pain and restricted range of motion. Clinical and radiological investigations revealed signs of inflammatory pathology, including elevated serum markers and imaging findings consistent with arthritis. Histopathological examination of the synovial tissue confirmed tubercular arthritis. The patient underwent surgical debridement followed by TKA. Postoperatively, the patient demonstrated significant functional improvement and was closely monitored over a 2-year follow-up period, with no recurrence of infection or prosthesis-related complications.
The atypical presentation of tubercular arthritis of the knee poses a diagnostic challenge and carries a high risk of mismanagement if not properly evaluated. This case underscores the importance of thorough radiological and histopathological assessments for accurate diagnosis. Our findings suggest that a combined approach of debridement and TKA offers effective results, minimizing the risk of post-operative complications, including periprosthetic joint infections. This report adds valuable evidence to the orthopedic literature, demonstrating that TKA is a viable option for managing tubercular arthritis of the knee, which provided that the diagnosis is confirmed, and appropriate surgical and medical protocols are followed.
结核病仍然是一项重大的全球卫生挑战，2022年报告了1060万新病例和130万例死亡。肺外结核约占所有病例的16%，骨关节结核是一个值得注意的子集。膝关节结核性关节炎是一种罕见的表现，由于其非典型表现常被误诊。全膝关节置换术（TKA）被认为是晚期病例的首选治疗方法；然而，关于偶然发现结核病例的治疗结果的证据仍然有限。本报告重点介绍了一例偶然诊断为膝关节结核性关节炎的病例，并评估了TKA后的临床结果。
一名55岁的南亚裔女性患者出现左膝关节进行性疼痛和活动范围受限。临床和影像学检查发现炎症性病变的迹象，包括血清标志物升高和与关节炎一致的影像学表现。滑膜组织的组织病理学检查证实为结核性关节炎。患者接受了手术清创，随后进行了TKA。术后，患者功能有显著改善，并在2年的随访期内接受密切监测，未出现感染复发或假体相关并发症。
膝关节结核性关节炎的非典型表现带来了诊断挑战，如果评估不当，管理失误的风险很高。该病例强调了进行全面的影像学和组织病理学评估以准确诊断的重要性。我们的研究结果表明，清创和TKA相结合的方法能产生有效的结果，将术后并发症（包括假体周围关节感染）的风险降至最低。本报告为骨科文献增添了有价值的证据，表明TKA是治疗膝关节结核性关节炎的可行选择，前提是确诊并遵循适当的手术和医疗方案。
