-
8/14/2019 Tuberculosis of Knee.pptx
1/17
Jithin.B.K
TB Knee
-
8/14/2019 Tuberculosis of Knee.pptx
2/17
The disease may begin as
Osseous tuberculosis
Tibial condyle
Femoral condyle
Patella (rare)
Synovial tuberculosis
-
8/14/2019 Tuberculosis of Knee.pptx
3/17
In the early stages of the
disease
Disease is confined to the
synovium.No significant damage to
the joint.
-
8/14/2019 Tuberculosis of Knee.pptx
4/17
In the late stages of the
disease
Articular cartilage and bone
are destroyed.
Synovial hypertrophy. Synovial effusion.
Pus formation.
Cartilage gets detached leaving
the bone exposed.
-
8/14/2019 Tuberculosis of Knee.pptx
5/17
Late stages (Contd)
Associated destruction of
ligaments.
Results in typical Triple
displacement of Tibia.(Tibial flexion, posterior
subluxation, and external
rotation). Pus may burst out of capsule
to present as a cold abscess,
and subsequently a sinus.
-
8/14/2019 Tuberculosis of Knee.pptx
6/17
Clinical Features
Age group 10-25 years.
Painand swellingin the knee.
Gradual onsetw/o any history
of trauma.
Subsequently, pain increasesand knee takes an attitude of
flexion. Patient starts limping.
Severe stiffnessto the knee.
-
8/14/2019 Tuberculosis of Knee.pptx
7/17
On examination
Swollen joint. Muscular atrophy.
Cold abscess.
Discharging or healed sinus. Limited movements.
Deformity of joint.
Mild flexion deformity in early
stages.
Triple displacement deformity inlate stages.
-
8/14/2019 Tuberculosis of Knee.pptx
8/17
Investigations:
Radiological investigations
Soft tissue shadow corresponding to
distended knee.
Wider joint space.
Diffuse osteoporosis.
Juxta-articular lytic lesions.
Joint surface erosion.
Joint space diminished or lost. Triple subluxation with
cavitatory
bone lesions in advanced stages.
-
8/14/2019 Tuberculosis of Knee.pptx
9/17
-
8/14/2019 Tuberculosis of Knee.pptx
10/17
-
8/14/2019 Tuberculosis of Knee.pptx
11/17
-
8/14/2019 Tuberculosis of Knee.pptx
12/17
Other investigations
Blood examination: Lymphocyticleucocytosis, high ESR.
Mantoux test.
Serum ELISA to detect anti-
mycobacterium antibodies. Synovial fluid aspiration.
Aspiration of cold abscess andAFB examination of pus.
Histopathological examination ofgranulation tissue obtained
bybiopsy or curettage.
-
8/14/2019 Tuberculosis of Knee.pptx
13/17
Differential diagnosis
In early stages presenting
with synovitis, exclude...
Subacute pyogenic infection
Monoarticular rheumatoid
arthritis
Chronic traumatic synovitis
Rheumatic arthritis
Haemophilic arthritis
-
8/14/2019 Tuberculosis of Knee.pptx
14/17
Treatment
Aim of treatment is to achievea painless mobile joint.
In late stages, some amount of
pain and stiffness persists inspite of treatment.
Modalities:
CONSERVATIVE TREATMENT
OPERATIVE TREATMENT
-
8/14/2019 Tuberculosis of Knee.pptx
15/17
Conservative treatment:
ATT
General care
Local care of knee
Knee rested by applying below-
knee skin traction (or) above-
knee POP slab.
Helps in healing process.
Helps in associated muscle
spasm that keeps knee deformed.
-
8/14/2019 Tuberculosis of Knee.pptx
16/17
Operative Treatment:
Synovectomy:
In cases of purely synovial
tuberculosis.
Joint debridement: In cases where articular cartilage is
preserved.
Arthrodesis: Charnleyscompression arthodesis A
popular method.
In advanced stages with triple
subluxation and complete cartilage
destruction.
-
8/14/2019 Tuberculosis of Knee.pptx
17/17
the en
