Total hip arthroplasty for tuberculosis: a case series

Background The purpose of this study is to investigate the optimal surgical options for different kinds of advanced hip tuberculosis, which are still controversial. Methods We reviewed seven advanced hip tuberculosis patients received operations from November 2014 to September 2018. All patients received anti-tubercular chemotherapy at least 2 weeks preoperatively and twelve months postoperatively. One active case with sinus tract of seven patients underwent three-stage operations including two debridements/cement spacer implantations and one total hip arthroplasty, while the other six cases received one = stage arthroplasty surgery. All patients are followed up based on Harris score, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and X-ray. Results The mean follow-up time was 41.6 months, while no reactivation was detected. The average Harris score increased from 40.0 preoperatively to 89.4 at the final follow-up. ESR of 3 active hip tubercular cases decreased from 143.7 mm/L at diagnosis time to 6.7 mm/L at the final follow-up. CRP of 3 active hip tubercular cases decreased from 80.01 mg/L (range, 37.34-136.92 mg/L) at diagnosis time to 1.91 mg/L (range, 1.05-2.57 mg/L) at the final follow-up. The ESR and CRP of all patients had returned to normal level at the final follow-up. No prosthesis dislocation, loosening and neurovascular injury was found. Conclusions THA is an effective and safe option for hip tuberculosis. The essentials for good outcome include early diagnosis, regular perioperative anti-tubercular chemotherapy, radical debridement of inflamed tissue and necrotic bone, staged-operation if necessary.