Total hip arthroplasty in patients with active tuberculosis of the hip with advanced arthritis

Abstract

Osteoarticular tuberculosis (TB) in the hip and other joints is increasing and patients in developing countries commonly present with advanced joint destruction. We asked whether TB is reactivated after THA in these patients. We retrospectively reviewed 12 patients with an average age of 45 years who had advanced stages of hip destruction secondary to mycobacterium TB and who were treated with primary THA and prescribed perioperative antituberculous medication for 12 to 18 months postoperatively. Diagnosis in all these patients was confirmed by histopathology and culture. The minimum followup was 25 months (average, 41 months; range, 25-58 months). We observed no reactivation of TB in 11 patients who had Harris hip scores ranging from 86 to 97. One patient who postoperatively did not comply with the antituberculous chemotherapy had reactivation and superimposed infection through a nonhealing sinus tract; that patient underwent component removal and resection arthroplasty. When the infected tissue can be débrided and adequate antituberculous therapy is instituted the outcome of joint arthroplasty may not be adversely affected. THA in the tuberculous hip has a low risk of reactivation and produces good functional results.

Level of evidence: Level IV, therapeutic case series (no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–D

Preoperative radiographs show (A) femoral head destruction and (B) subluxation. (C) An MR scan shows active disease with a soft tissue abscess. (D) A radiograph obtained at the 43-month followup shows no evidence of osteolysis or disease reactivation.

Fig. 2A–E

A preoperative radiograph shows (A) femoral head destruction and a large acetabular cavity (arrow) with periarticular osteopenia. (B) Anteroposterior and (C) lateral radiographs show the hips after THA and reconstruction of an acetabular defect with morselized allograft bone grafting (arrow). Followup (D) anteroposterior and (E) lateral radiographs obtained at 45 months show good incorporation of the allograft (arrow), and no evidence of osteolysis or reactivation.