Arthroscopic operations in knee joint with early-stage tuberculosis.
BACKGROUND
Due to atypical clinical presentation, wide use of antibiotics and lack of specificity in diagnosis, misdiagnosis is common, and diagnosis of tubercular infection in a joint is increasingly difficult. The use of arthroscopy for the diagnosis and treatment of early-stage knee TB has rarely been reported. Through this case series we describe the usefulness of arthroscopy for the management of synovial tuberculosis of the knee joint.


METHODS
Synovectomy and synovial membrane biopsy were performed using arthroscopy in ten subjects suffering from synovial tuberculosis. This was combined with intra-articular isoniazid injection and systemic antituberculosis drugs.


RESULTS
In all cases, continuous passive motion exercise was started 2 days after operation and they were followed up from 6 months to 3 years. The flexion angles 90 degrees +/- 5 degrees preoperatively increased to 120 degrees +/- 14 degrees in nine patients following surgery, the extension limit angle also improved from an average 20 degrees +/- 3 degrees preoperatively to 5 degrees +/- 1 degrees postoperatively. There was a significant difference in knee function index between preoperation and postoperation (t = 6.9, t = 6.3, P < 0.01). Japanese Institute of Plastic Surgery synovial disease treatment success criteria was also improved from 44.4 +/- 8.4 points before surgery to 81.5 +/- 10.4 following surgery (t = 8.749, P < 0.01). The joint swelling disappeared or was relieved after 2 months. No relapse of tuberculosis was found at the time of follow-up.


CONCLUSIONS
Combined use of arthroscopy and antituberculosis medication appears to be advantageous for the management of early-stage synovial tuberculosis of the knee joint. Arthroscopic removal of the pannus allows better nutrition of the cartilage and thus greatly improves the joint function.
Shen
Hai-li
HL
Institute of Orthopaedics, The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, People's Republic of China.
Xia
Yayi
Y
Li
Peng
P
Wang
Jing
J
Han
Hua
H
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage; D001182:Arthroscopy; D001706:Biopsy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007538:Isoniazid / Q000008:administration & dosage; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000074402:Synovectomy; D013583:Synovial Membrane / Q000473:pathology; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000628:therapy
D000995:Antitubercular Agents; D007538:Isoniazid