Reactivation of ancient joint tuberculosis of the knee following total knee arthroplasty after 61 years: A case report

The prevalence of pulmonary tuberculosis is increasing and is associated with a rise in skeletal tuberculosis. Even after appropriate anti-tuberculosis therapy, reactivation of the infection may occur, even after many years. In this case report we describe a patient who had a reactivation of tuberculosis in the knee after total knee arthroplasty. At the age of 14 years, the patient had isolated tuberculosis arthritis of the left knee. Reactivation occurred after total knee arthroplasty 61 years later, at the age of 75. The patient was treated with a combined therapy; first the joint was irrigated with povidine-iodine and saline solution, and gentamicin beads were left behind. When the cultures revealed Mycobacterium tuberculosis, drug therapy of isoniazid, rifampicin, ethambutol and pyrazinamide was started and was continued for 9 months postoperatively. At a recent follow-up, the patient is doing well, with good range of motion in the knee.