[Acute exacerbation of tuberculous osteoarthritis of the knee caused by trauma: clinical management].
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Sauer
B
B
Fachkrankenhaus für Orthopädie, Waldkrankenhaus Bad Düben. bettina_sauer@hotmail.com
Hofmann
G O
GO
Tiemann
A
A
D000369:Aged, 80 and over; D000844:Ankylosis / Q000175:diagnosis / Q000601:surgery*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001174:Arthrodesis; D017577:Cutaneous Fistula / Q000188:drug therapy / Q000209:etiology; D003646:Debridement; D003937:Diagnosis, Differential; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D007718:Knee Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009163:Mycobacterium bovis; D010166:Palliative Care; D011182:Postoperative Care; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis / Q000601:surgery*
D000995:Antitubercular Agents