One-stage Total Joint Arthroplasty for Patients With Active Tuberculosis

Zhang, Yi Chao; Zhao, Hong

doi:10.3928/01477447-20130426-02

Cited by 11 publications

(15 citation statements)

References 24 publications

(40 reference statements)

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“…Traditionally, the surgical treatment for advanced active TB of the hip includes debridement, arthrodesis, and resection arthroplasty combined with a certain period of antituberculosis therapy [ 2 , 12 ]. Arthrodesis is no longer popular in the Asia-Pacific region because of the customary need for squatting, kneeling, and sitting cross-legged.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, one-stage THA requires strict indications and proficient technical skills. Based on the summary of all reports, the success of one-stage THA for active TB of the hip is subject to three key points: (1) perioperative antituberculous therapy, (2) thorough debridement and complete curettage of infected tissues at the time of operation, and (3) best without sinus drainage [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most authors suggest that patients with sinus drainage are not well qualified for one-stage joint arthroplasty [ 3 , 11 , 12 , 14 , 15 ]. The presence of sinus drainage usually indicates pyogenic superinfections.…”

Section: Discussionmentioning

confidence: 99%

“…With a radical debridement and a complete course of antituberculous chemotherapy perioperatively, one-stage THA has been considered as a safe method to treat active tuberculosis of the hip by several authors [ 5 , 8 – 11 ], but it requires strict indications and proficient technical skills. If one-stage THA was chosen to treat active hip tuberculosis, complete curettage and debridement of infected tissues at the time of operation would be a crucial procedure to guarantee the success of surgery [ 12 , 13 ]. Shen et al .…”

Section: Introductionmentioning

confidence: 99%

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Two-stage total hip arthroplasty for patients with advanced active tuberculosis of the hip

et al. 2016

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BackgroundTreatment of advanced active tuberculosis (TB) of the hip is confronted with great challenges. Although one-stage total hip arthroplasty (THA) is considered as a safe procedure for most patients by some authors, there are still exceptions. The purpose of this paper was to investigate the feasibility and effectiveness of two-stage THA for selected patients with advanced active TB of the hip.MethodsNine consecutive patients with advanced active tuberculous arthritis of the hip were reviewed in this study. Out of these nine patients, the hips of five were destroyed extensively with difficulties of thorough debridement at one operation, and the hips of the other four were detected of sinus tracts. Nine patients received the two-stage total hip arthroplasty (THA) protocol and the perioperative antituberculous medication between January 2008 and December 2013. During the first stage, a debridement was carried out after at least 2 weeks of antituberculous chemotherapy to remove abscesses and infected and necrotic tissues as thoroughly as possible, followed by antituberculous chemotherapy for a minimum of 3 months (average 4.2 months). During the second stage, hip prosthesis was implanted if the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) were normal and the wound was well healed. Antituberculous chemotherapy was continued for 6–9 months postoperatively to constitute a total duration of a minimum of 12 months after the first operation. The patients were then evaluated based on the reactivation of infection, the Harris hip score system, X-ray, ESR, and CRP.ResultsThe average follow-up was 40 months (range, 18–72 months). No reactivation of TB or superimposed infection was observed in all patients. The ESR and CRP returned to the normal level with no liver injury. The average Harris hip score was increased from 35 (range, 15–55) preoperatively to 91.5 (range, 83–97) at the final follow-up. The X-ray film showed no prosthesis shift or loosening.ConclusionsTwo-stage THA is an alternative treatment option for patients with advanced active tuberculosis of the hip under some difficult conditions. The hip with sinus tracts or destroyed extensively with difficulties of thorough debridement at one operation may be regarded as indications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Two-stage total hip arthroplasty for patients with advanced active tuberculosis of the hip

et al. 2016

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“…So in postoperative follow up if patient has signs of infection with culture showing negative the surgeons should be aware of possibility of TB in the joint. To achieve successful outcome we should plan proper pre, peri and postoperative TB care with or without debridement and during the procedure we should completely curette inflamed soft tissues and necrotic bone 1 . Pre op TB regimen should be for atleast two weeks so that inflammatory markers (ESR and CRP) 1 show positive reaction and post-operative regimen should be for minimum of 12 -15 months 6 .…”

Section: Sri Ramachandra Medical College Chennaimentioning

confidence: 99%

Total Knee Replacement in Tuberculous Arthritis – Reporting an Unsuspected Case

Vyravan¹,

Choudhary²,

Kumar³

2014

IOSRJDMS

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Total knee arthroplasty is done to reduce pain and disability in elderly individuals with conditions like osteoarthritis and rheumatoid arthritis. One of the dreaded complications of TKR is infection which causes surgery a total failure and furthermore the subsequent treatment becomes more complicated and causes more morbidity and financial expenditure to the patient. TKR to treat active joint tuberculosis remains controversial and most authors advice not to do joint replacements in cases with active discharging sinuses 1, 4, 9 -11 . As a precaution it is always necessary to rule out infection pre operatively by thoroughly investigating the patient. But sometimes we can encounter unexpected things.A 55 year old female who was apparently normal two years back developed right knee pain. Pain is insidious, continuous, not associated with fever or any trauma. She is not a known case of TB of any other organ. But she is a known case of rheumatoid arthritis and epilepsy, on treatment. On investigating she had increased ESR of 56 for one hour, CRP is elevated to 2.4 and serum alkaline phosphatase elevated to 155.As there were no signs to suspect active TB in any of the systems or organs both clinically and radiologically, we proceeded with the total knee replacement. But on opening the joint synovium looked inflamed and hence it was sent for biopsy and TKR was completed with Genesis II (Smith and Nephew). The biopsy report came as granulomatous lesion consistent with tuberculosis. Synovium specimen showed epithelioid granuloma with Langhans Giant cells. But AFB and fungal staining came as negative. Post operatively patient was started on Anti TB treatment. Patient was mobilized next day of surgery with active knee bending exercises and after one week patient was made to walk full weight bearing and patient had no pain. Sutures were removed fifteenth post op day and discharged. Patient had been followed up for six months so far without any reactivation of tuberculosis. Six months follow up post op x-ray did not show any osteolysis of both femoral and tibial components. Skeletal tuberculosis is a common infection in India which is around 2% of all musculo skeletal tuberculosis. In the musculo skeletal system it affects most commonly the spine and next in order is hips and knees. When literature was reviewed TKR has been advised for subclinical TB and there are reports that TKR reduces pain, restores excellent range of motion and even TB gets cured and reactivation of TB is less. But in

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