Total Knee Arthroplasty in Tuberculous Arthritis of the Knee - A Case Report.

Abstract

Introduction: 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.

Case report: 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.

Conclusion: 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.