Most of the world's experience in managing musculoskeletal tuberculosis is reported from outside of the United States. Yet, the prevalence of this disease in the United States is substantial and, according to recent data, may be on the rise. To raise awareness and improve management of this disease, we report the case of a patient with advanced, active, and refractory tuberculous arthritis of the knee with extensive joint destruction. Our patient was managed with medical therapy and a two-stage surgical approach that was designed to sterilize the joint and permit successful total knee arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and he consented.

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