Application of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage tuberculosis of the knee

Background With the global determination to eliminate tuberculosis (TB), the treatment for end-stage TB of the knee joint is still a great clinical challenge. This study aims to retrospectively determine the clinical and radiographic outcomes after use of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage knee TB. Methods Twenty-six patients with end-stage knee TB treated by external fixation with the Ilizarov fixator between 2012 and 2017 were examined. Anti-TB drugs were administered preoperatively, intraoperatively, and postoperatively. Clinical and radiologic examinations were performed for comprehensive evaluations, and these include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), flexion and valgus angle of the knee, leg-length discrepancy, and Lysholm score. Results Twenty-four patients were followed up for an average of 5.8 years (2.2-7 years). All patients achieved bone fusion within a mean of 6.4 months (4-16 months). The ESR and CRP concentrations were observed to return to normal within 5.1 +/- 1.1 months postoperatively. There was no recurrence of TB. At last follow-up, the mean leg-length discrepancy was 2.7 +/- 1.4 cm, and the mean alignment was 8.7 +/- 2.6 degrees flexion and 5.3 +/- 1.0 degrees valgus. No patient had a significant rotational deformity. The average Lysholm score was seen to improve significantly from 36.8 +/- 18.4 preoperatively to 79.5 +/- 5.9 at final follow-up (p < 0.0001). Conclusion This study has demonstrated that the Ilizarov technique for knee joint arthrodesis as a treatment of end-stage knee TB achieved promising outcomes with minimal complications.