Early debridement improves outcome in managing ankle tuberculosis: a systematic review

Introduction: Extrapulmonary tuberculosis (EPTB) accounting for 10% of all cases and the involvement of the musculoskeletal system was only 3%, in which the spinal TB is the most common form. The incidence of ankle TB was found to be less than 1% of all musculoskeletal TB and often misdiagnosed. In Indonesia, the prevalence of TB is 660 from 100,000 people. There is no known data for EPTB, including musculoskeletal TB. The diagnosis of tuberculosis infection in a joint is difficult. Untreated ankle TB and diagnostic delay may result in local cartilage destruction and functional disability, leading to a poorer prognosis. This systematic review aims to find out if early surgical treatment of ankle TB affects the outcomes and the importance of laboratory tests of ankle TB. Our hypothesis predicts better outcomes with earlier surgical treatment for ankle TB. Methods: EBSCO, Proquest, Pubmed, ScienceDirect, and Google Scholar were searched using the terms “ankle”, “tuberculosis”, “arthroscopy”, “debridement” and “open”. After identification and review of the included study publications, these variables were extracted from the studies: authors, publication year, place, age, delayed onset of surgery, clinical findings, laboratory and diagnostic findings, surgery technique, tuberculosis drug, and outcome.The inclusion criteria included studies on arthroscopic or open debridement surgical management of ankle tuberculosis, English-language studies, and articles published between 2004-2019. The exclusion criteria included studies that perform arthrodesis and patients with multi-drug resistance tuberculosis. Results: After an initial search of 59 studies, 19 duplicates were removed and the final remaining 11 studies were used for inclusion (6 case-control studies, 4 case series, and 1 cohort). The studies considered were all published between 2010 and 2019. In total, there are 103 patients with a mean age of 43.8 years (7-90) treated for ankle TB with arthroscopy debridement, open debridement, and synovectomy. The mean delayed time of surgery is 10.9 months (1-80) and outcomes were evaluated over a mean of 35.5 months postoperatively (1.5-260). All patients were treated with Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE) with mean of treatment of 10 months (ranges from 4-21). No patients were lost to follow up. Conclusion: Early debridement is recommended to improve outcomes in managing ankle TB.