Inflammatory arthritis and Mycobacterium Tuberculosis infection: a diagnostic and management challenge for Knee arthroplasty in endemic areas

Obada Hussein Hasan, Aga Khan University
Riaz Hussain Lakdawala, Aga Khan University
Vickash Kumar
Syed Faisal Mahmood, Aga Khan University
Shahryar Noordin, Aga Khan University


Tuberculosis continues to be one of the most challenging health problems more prevalent in developing countries. Pakistan ranks 5th in tuberculosis prevalence among the high-burden countries. Prosthetic joint infection of the knee by acid fast bacilli is a rare and distressing complication, occurring in nearly 1% of primary joint arthroplasties requiring prolonged medical treatment and multiple surgeries. A recent publication extensively reviewed English literature from 1952 to 2016, and reported only 64 prosthetic joint infection with tuberculosis, of which 27 cases involved the knee. Tuberculosis is a global health problem adding to the challenges that arthroplasty surgeons face in our resource-constrained setting. Furthermore, it presents as other inflammatory arthritis with almost same laboratory and radiological findings. The current paper was planned to highlight the preoperative and postoperative challenges that the arthroplasty surgeon may have in diagnosis and management of this rare infection. We included studies from 1996 to date which reported knee tuberculosis prosthetic joint infection that were managed by medication alone or with surgica