Description of patient (type of occupation, indication of age, intensity of sport):
A 24-year-old man.
History and previous treatment:
No history or previous treatment.
Current complaints:
Patient presented with pain and swelling in the right ankle joint on and off in nature for duration of about 2 years. His pain and swelling used to subside on consumption of analgesics and rest. It used to increase during excertion like (walking for long duration/ running/ playing cricket as bowler/ travelling for long distances.
Physical examination:
Antalgic gait when walking for long distance, Gait after adequate rest is normal. Fullness of the posterior medial and lateral malleolar fossa. No local rise of temperature. Movements dorsiflexion terminally restricted.
Radiology:
X-ray:
[Picture 11]
Additional investigation (CT/MRI):
[Picture 2]
Arthroscopic images showing cartilage seperation from the subchondral bone. The joint was debrided and synovial was sent for Semi nested Real time PCR on GeneXpert platform. It was reported as Mycobacterium Tuberculosis detected and resistance was found to drug Rifampicin.
Images:
Case summary:
Patient was diagnosed for Tuberculosis of the right ankle joint and was put on Anti- tubercular drugs for duration of 9 months. He was initially non weight bearing. Later on weight bearing as tolerated.
Question(s) to this case:
He has completed his course of antitubercular drugs. There is extensive loss of cartilage from the talar dome and tibial articular surface and he does have pain. What can be done to improve his lifestyle, as he wants to walk for long distances and travel long distances for work purposes.
Expert:
The only option is arthrodesis.