Two-stage operation to treat destructive midfoot tuberculosis: 14 cases experience

Orthop Traumatol Surg Res. 2016 Dec;102(8):1075-1080. doi: 10.1016/j.otsr.2016.07.007. Epub 2016 Aug 27.


Introduction: Tuberculosis (TB) in midfoot is often secondary to tuberculosis elsewhere in the body. The experience and literatures to treat midfoot tuberculosis are rare. Up until now, no successful method is reported to treat midfoot tuberculosis.

Hypothesis: Stage surgery is an effective method to treat midfoot bone TB.

Material and methods: Between January 2008 to January 2011, 14 patients who were diagnosed midfoot tuberculosis and suffered stage operation were enrolled. All the patients had been diagnosed definitely relying on imaging examination and laboratory tests preoperatively. Two-stage operation was performed to all patients. At the first stage, TB tissue and infective tissue were completely removed and replaced by antibiotic bone cement. Normal foot length and arch would be restored and maintained by K-wires and external fixators. At the second stage, autologous iliac and allogeneic bone graft were used to replace bone cement and by fixed by locking plates. American Orthopaedic Foot and Ankle Society (AOFAS), SF-36 and visual analogue scale (VAS) pain score were recorded at the last follow-up.

Results: The average bone union time was 3.8 (range 3-6) months. There is no case of local recurrence or skin sinus. Neither implant broken nor screw loosen was present in this study. The AOFAS score was increased from 51.7±6.8 (range 43-61) preoperatively to 82.9±3.9 (range 76-90) postoperatively (P<0.001). The SF-36 score increased from 46.1±6.1 preoperatively to 83.1±5.4 postoperatively (P<0.001). The VAS score decreased from 6.1±1.1 preoperatively to 1.4±0.9 points postoperatively (P<0.001).

Discussion: Stage operation is an effective treatment to stage III, IV midfoot tuberculosis.

Levels of evidence: Level IV, retrospective.

Keywords: Midfoot; Stage operation; Tuberculosis.

MeSH terms

  • Adult
  • Bone Cements
  • Bone Plates
  • Bone Screws
  • Bone Transplantation
  • Bone Wires
  • External Fixators
  • Female
  • Foot Joints / surgery*
  • Humans
  • Ilium / transplantation
  • Male
  • Metatarsal Bones / surgery*
  • Middle Aged
  • Orthopedic Procedures / instrumentation
  • Orthopedic Procedures / methods*
  • Plastic Surgery Procedures / instrumentation
  • Plastic Surgery Procedures / methods*
  • Retrospective Studies
  • Tarsal Bones / surgery*
  • Transplantation, Autologous
  • Transplantation, Homologous
  • Treatment Outcome
  • Tuberculosis, Osteoarticular / surgery*


  • Bone Cements