Total hip replacement in active advanced tuberculous arthritis

Abstract

We describe the results of cemented total hip replacement in 23 patients (23 hips) with active tuberculous arthritis of the hip with a mean follow-up of 4.7 years (4 to 7). In two patients the diagnosis was proved by pre-operative biopsy, whereas all others were diagnosed on a clinicoradiological basis with confirmation obtained by histopathological examination and polymerase chain reaction of tissue samples taken at the time of surgery. All patients received chemotherapy for at least three months before surgery and treatment was continued for a total of 18 months. Post-operative dislocation occurred in one patient and was managed successfully by closed reduction. No reactivation of the infection or loosening of the implant was recorded and function of the hip improved in all patients. Total hip replacement in the presence of active tuberculous arthritis of the hip is a safe procedure when pre-operative chemotherapy is commenced and continued for an extended period after operation.

Evaluation of pattern and treatment of osteoarticular tuberculosis in central India

“…Sidhu AS et al, 27 Yong qing Wang et al 28 , Kim et al 29 in their respective studies also concluded that THR in patients with active TB of the hip is a safe procedure. If undertaken in association with extensive debridement and appropriate anti-TB treatment, it provides symptomatic relief and functional improvement.…”

One-stage Total Joint Arthroplasty for Patients With Active Tuberculosis

“…Recently, several clinical reports have introduced 1-stage total joint arthroplasty for the treatment of active tuberculosis of the hip or knee joint. [1][2][3][4][5][6][7][8][9][10][11][12] Tuberculosis is an infectious disease found in 2% to 5% of all tubercular lesions in the body. 1 The spine is the most common site of bone involvement, followed by the hip and knee joints.…”

“…Current published studies for this clinical research analysis all had a minimum of 4 patients (Table). [6][7][8][9][10][11][12] Su et al 6 reviewed 15 patients (16 knees) who underwent 1-stage joint arthroplasty to treat active and quiescent-stage knee joint tuberculosis. Patients were divided into 2 groups: those in group A (8 knees) were diagnosed with tuberculosis and preoperatively received 2 to 20 months of anti-tuberculosis therapy, and those in group B (8 knees) were not diagnosed with tuberculosis preoperatively so they did not receive preoperative antituberculosis therapy.…”

“…n guest editorial Sidhu et al 8 reported 23 patients, the majority of whom were diagnosed with active hip tuberculosis on a clinicoradiological basis, with confirmation obtained from histopathological examination and polymerase chain reaction with tissue samples taken intraoperatively. All patients received anti-tuberculosis therapy 3 months pre-and 18 months postoperatively.…”

“…At an average followup of 4.7 years, clinical outcomes were satisfactory without any reactivation. 8 So, why is 1-stage total joint replacement able to treat patients with active joint tuberculosis? First, the distinctive biological characteristic of M tuberculosis shows that this bacterium divides every 15 to 20 hours, which is extremely slow compared with other bacteria (such as Staphylococcus aureus, which has a division time of approximately 20 minutes).…”