TO THE EDITOR:
I read with interest "The Utility of Histological Examination of Tissue Removed during Elective Joint Replacement. A Preliminary Assessment" (80-A: 331—335, March 1998), by Raab et al.
Another diagnosis that may be missed if a specimen of the synovial tissue is not sent for histological study is tuberculosis.
I reported a case of unsuspected tuberculosis of the knee1, which illustrates how tuberculosis can be missed. I know of two other patients in whom tuberculosis was discovered after total knee replacement. All three patients received treatment for the tuberculosis as soon as it was recognized, and all of the prosthetic knees survived.
Michael Besser, F.R.C.S., F.R.C.S.E.: Rambam Medical Center, Unit of Knee and Arthroscopic Surgery, P.O. Box 9602, Haifa 331096, Israel