Recurrence Risk and Functional Outcomes of Total Knee Arthroplasty in Tuberculous Arthritis: A Systematic Review and Meta-Analysis

Musculoskeletal tuberculosis (TB) of the knee presents major reconstructive challenges due to joint destruction, ankylosis, and deformity. While total knee arthroplasty (TKA) is a proven solution for end-stage arthritis, its use in TB-affected knees raises concerns of recurrence, perioperative complications, and prosthesis survival. This review aims to evaluate functional outcomes and recurrence rates following knee arthroplasty in tuberculosis and assess the impact of ATT duration and surgical strategy. A systematic search following PRISMA guideline (PROSPERO: CRD420251158365) was performed on PubMed, Embase, and Scopus on 10 June 2025. Continuous outcomes were pooled using random-effects meta-analysis (SMD, 95% CI), and dichotomous outcomes were analyzed using a random-effects model with Freeman-Tukey transformation. Heterogeneity was assessed with I2, and subgroup differences were evaluated using Chi-square tests; P < 0.05 was considered significant. Across 10 studies including 234 knees, postoperative outcomes improved significantly. KSS Knee scores increased from 35.3 to 83.5 (SMD − 3.59, 95% CI − 4.61 to − 2.58, P < 0.05), KSS Function from 32.7 to 84.2 (SMD − 3.99, 95% CI − 6.19 to − 1.79), and HSS from 37.0 to 85.9 (SMD − 6.75, 95% CI − 10.71 to − 2.78). Overall recurrence was 9%, with higher rates seen with preoperative ATT < 3 months and postoperative ATT < 12 months. Single-stage procedures had a slightly higher recurrence rate than two-stage procedures, though not statistically significant. Knee arthroplasty in tuberculosis significantly improves functional outcomes, and adequate pre and postoperative ATT reduces recurrence. Both single and two-stage procedures are effective when combined with optimal medical therapy.