title: Long-term retrospective analysis of surgical treatment for irretrievable tuberculosis of the ankle.
abstract: BACKGROUND
  Although antituberculosis medication is the first step in the management of skeletal tuberculosis (TB), surgical debridement, biopsy, synovectomy, or arthrodesis may be needed for the definitive diagnosis and treatment of the symptomatic ankle.
  
  
  METHODS
  Twenty-nine patients with TB around the ankle joint were enrolled during a 23-year period and followed for 73.1 months (range, 30-260 months) after TB was controlled. Among 61 surgical procedures performed in 29 patients, complete resolution of ankle TB was seen in 28 patients.
  
  
  RESULTS
  According to Martini and Ouahes classification, radiographic findings of localized osteoporosis were stage I in 4 patients, one or more erosions were stage II in 9 patients, destruction of the whole joint was stage III in 8 patients, and anatomic disorganization and subluxation were stage IV in 8 patients. Functional results were excellent in 6 patients and good in 16 patients, but with talar bone collapse or hindfoot malalignment, a fair result was noted in 6 patients. The diagnostic accuracy rates were 28.5% with aspiration of synovial fluid, 66.7% in histological analysis, and 44.4% in bacteriological analysis. Mixed infection with bacterial flora was noted in 8 patients (27.6%).
  
  
  CONCLUSIONS
  Ankle TB is easily misdiagnosed and may ultimately involve the peritalar neighboring joints with talar height loss or hindfoot deformity. Successful treatment depends on the extent of disease at presentation, accurate staging, duration of adequate chemotherapy, and optimal surgical intervention.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopedic Surgery, Tzu Chi University, Taichung, Taiwan.
authors.forename: Shih-Hao
authors.initials: SH
authors.lastname: Chen
authors.forename: Chen-Hsiang
authors.initials: CH
authors.lastname: Lee
authors.forename: To
authors.initials: T
authors.lastname: Wong
authors.forename: Huei-Shian
authors.initials: HS
authors.lastname: Feng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000382:microbiology* / Q000601:surgery*; D001706:Biopsy; D002648:Child; D003646:Debridement; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000074402:Synovectomy; D013583:Synovial Membrane / Q000382:microbiology; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000601:surgery*