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.