Surgical Management of Aggressive Knee Tuberculosis with Open Subtotal Synovectomy - A Case Report and Review of Literature.

Introduction: Skeletal tuberculosis (TB) accounts for approximately 10-35% of the extra-pulmonary cases, where knee TB accounts for around 8% of extra-pulmonary TB cases after hip and spine. In about one-third of patients with extra-pulmonary TB, pulmonary TB is concomitantly found. The management of knee TB poses an initial diagnostic challenge due to its non-specific symptoms and absence of constitutional symptoms after which depending on the response to AKT - surgical intervention open or arthroscopic could be contemplated. Case Report: We have a 30-year-old female patient diagnosed with the right-sided knee TB on synovial biopsy started on anti-tubercular treatment. After 1 month of conservative middle path regimen, She presented to us with worsening knee pain and swelling over the right knee and difficulty in standing and moving out of bed as well as inability to sleep and night cries affecting significantly her activities of daily living. The patient was managed with open arthrotomy and subtotal synovectomy was done along with thorough debridement resulting in significant reduction in the pain and swelling in the post-operative period with return of range of motion with daily activities. Conclusion: As clear in our case, apart from the conventional chemotherapeutic regimen for TB, surgical management is sometimes indicated in patients with an aggressive joint infection with severe impairment in performing activities of daily living. It also helps to decrease the disease load which provides symptomatic relief to the patient and helps in recovery, thereby improving the quality of life.