Cementless total hip arthroplasty in advanced tuberculosis of the hip

Abstract

Purpose: The use of total hip arthroplasty (THA) to treat advanced tuberculous arthritis, particularly during the active phase, is challenging. The aim of this study was to evaluate the efficacy of cementless THA for advanced hip joint tuberculosis.

Methods: This study reviewed 32 patients (mean age at surgery, 49.4 years [range, 24-79 years]) who underwent cementless THA between 2007 and 2012. All patients were diagnosed with advanced tuberculosis of the hip on the basis of clinical manifestations, radiographic findings, and histological examination. All procedures were performed by a single surgeon. Mean follow-up period was 4.1 years (range, 2-7 years). Thorough debridement of tuberculosis-infected tissues and antitubercular therapy were conducted intra-operatively. Clinical data, including visual analog scale (VAS) score, Harris hip score (HHS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and complications, as well as radiologic data, including prosthesis subsidence and loosening, bone growth, and heterotopic ossification, were evaluated during follow-up.

Result: Mean VAS decreased from 7.6 (range, 5-10) pre-operatively to 1.4 (range, 0-4) at final follow-up (P < 0.01). Mean HHS improved from 42.2 (range, 30-75) pre-operatively to 85.4 (range, 60-95) at final follow-up (P < 0.01). No signs of reactivation were detected. In all patients, ESR and CRP levels were within normal limits by a mean of three and four months, respectively, and radiologic results during follow-up indicated favourable prosthesis positioning and condition.

Conclusion: Despite the state of tuberculosis, cementless THA was an effective treatment for advanced tuberculosis of the hip.

Keywords: Active-phase tuberculosis; Cementless; Total hip arthroplasty; Tuberculosis of the hip.