Total hip arthroplasty for active tuberculosis of the hip

Abstract

Total hip arthroplasty (THA) has been used as a successful form of treatment in patients with long-standing tuberculosis, but it is unclear whether THA should be performed in patients with current infection. We performed THA in six patients with advanced active tuberculosis of the hip from 2002 to 2006. Tuberculosis was confirmed in all cases by histological examination. All patients were treated with antituberculous medications for at least two weeks followed by thorough debridement and THA. Antituberculous medications were administered postoperatively for at least 12 months. The duration of postoperative follow-up was an average of 49 months. No reactivation of the infection was detected in our series. Using the Harris hip score system, five of the patients were classified as excellent and one as good. THA in advanced active tuberculosis of the hip is a safe procedure providing symptomatic relief and functional improvement. Thorough debridement of infected tissues and postoperative antituberculous therapy are the keys to lowering the potential risk of reactivation of tuberculosis.

Fig. 1

a A preoperative radiograph of a 50-year-old man with tuberculosis of the hip revealing bony destruction and pathological fracture of the femoral neck. b The CT scan showing bony destruction and pathological fracture of the femoral neck and cold abscess within the joint cavity. c Thirty-five months postoperatively, the patient has a normal gait and there are no signs of prosthetic loosening

Fig. 2

a A preoperative radiograph of an 18-year-old man with tuberculosis of the hip revealing bony destruction. b The CT scan showing bony destruction and cold abscess around the femoral head. c Eighty months after surgery, the patient had a normal gait and the radiograph showed no loosening of the prosthesis