Knee Tuberculosis | Diagnosis

Описание: This lecture on Orthopedic Surgery will cover knee tuberculosis, including its pathology, clinical features, diagnosis, and treatment.

Although pulmonary tuberculosis is more commonly known and affects 60-70% of patients, extrapulmonary manifestations, including joint (osteoarticular) infections, also exist.
While these types of infections are more common in immunocompromised patients, they remain relatively rare.

▬ 📌 Knee Tuberculosis Pathology
The disease typically starts in the synovium, which is the membrane that lines the joint and can spread to other structures in the joint, such as the bone and cartilage. The bacteria cause an inflammatory response in the synovium, leading to swelling, pain, and stiffness in the joint.

This chronic inflammation can result in the formation of granulomas, which are nodules of immune cells that try to contain the infection.
Over time, inflammation and tissue damage can lead to irreversible joint damage if left untreated.

As the disease progresses, the bacteria can spread to other areas of the joint, such as the bone and cartilage. In the bone, the bacteria can cause osteomyelitis, which is an infection of the bone.

This can cause bone destruction and deformity, which can further exacerbate joint damage.
In cartilage, the bacteria can destroy the articular surfaces, which are the surfaces of the joint that allow for smooth movement.

Early diagnosis and treatment are important for preventing irreversible joint damage and achieving the best possible outcomes.

▬ 📌 Knee Tuberculosis Clinical Features
The clinical features of knee tuberculosis can vary depending on the stage of the disease. Early symptoms may include pain, swelling, and stiffness in the joint, which can be mistaken for other joint disorders. As the disease progresses, the pain may become more severe, and the joint may become deformed. Other symptoms may include fever, night sweats, and weight loss.

▬ 📌 Knee Tuberculosis Diagnosis
The diagnosis of knee tuberculosis is based on a combination of clinical evaluation, laboratory tests, and imaging studies. Laboratory tests such as the erythrocyte sedimentation rate (ESR) and the Mantoux test can help to confirm the diagnosis. Radiological studies, such as X-rays and MRI, can also help to identify characteristic changes in the joint associated with tuberculosis.

▬ 📌 Knee Tuberculosis Differential Diagnosis
Differential diagnosis is an important aspect of diagnosing knee tuberculosis, as other conditions can mimic the symptoms of tuberculosis. Some of the conditions that should be considered in the differential diagnosis of knee tuberculosis include monoarticular affections, rheumatoid arthritis, synovial chondromatosis, hemarthrosis, synovioma, foreign body granuloma, and dysenteric arthritis.

▬ 📌 Knee Tuberculosis Non-Surgical Treatment
The initial treatment for knee tuberculosis is pharmacotherapy with anti-tuberculosis drugs. This typically involves a combination of medications, including isoniazid, rifampicin, pyrazinamide, and ethambutol. The treatment course may last for 12-18 months, depending on the severity of the disease. In addition to medication, patients may be advised to use a bed splint to support the knee and aid recovery.

▬ 📌 Knee Tuberculosis Surgical Treatment
Surgical treatment of knee tuberculosis is usually reserved for cases where there is significant destruction of the joint or failure of conservative management. The type of surgical treatment will depend on the size and progression of the disease.

In the synovial stage, arthrotomy and synovectomy may be performed to remove the infected tissue.
In more advanced stages, arthrodesis or joint fusion may be necessary to stabilize the joint. In some cases, joint replacement surgery, or arthroplasty, may be necessary to restore joint function.

Post-Operative Treatment
Following surgical treatment, patients will require a period of rehabilitation to regain joint function.

This typically involves a combination of triple-drug therapy, traction, intermittent active and assisted exercises, and suitable brace ambulation.
The specific treatment plan will depend on the individual patient's needs and the extent of joint damage. It is important to follow the post-operative treatment plan closely to ensure the best possible outcome.

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