Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2015; 6(8): 636-640
Published online Sep 18, 2015. doi: 10.5312/wjo.v6.i8.636
Total hip replacement for arthritis following tuberculosis of hip
Vijay Kumar, Bhavuk Garg, Rajesh Malhotra
Vijay Kumar, Bhavuk Garg, Rajesh Malhotra, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: All authors contributed equally to the study.
Institutional review board statement: The study was reviewed and approved by the Institute Ethics Committee of All India Institute of Medical Sciences, New Delhi.
Informed consent statement: This study was a retrospective analysis of the patients records, therefore no active patient/participant contact was required. As the study did not involve any active patient contact and involved analysis of records, a “Waiver of Consent” was granted by the ethics committee. All data collection was depersonalized before analyzing therefore maintaining confidentiality of the patients.
Conflict-of-interest statement: None of the authors had any conflict of interest to declare.
Data sharing statement: The dataset is available from the corresponding author at rmalhotra62@yahoo.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rajesh Malhotra, Professor of Orthopaedics, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. rmalhotra62@yahoo.com
Telephone: +91-11-26593589
Received: April 24, 2015
Peer-review started: April 24, 2015
First decision: May 13, 2015
Revised: June 16, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: September 18, 2015
Abstract

AIM: To present the results of total hip arthroplasty (THA) for post tubercular arthritis of the hip joint.

METHODS: Sixty-five patients (45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years (range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction (PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also recorded.

RESULTS: The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years (range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min (range, 65-125) whereas the mean blood loss was 600 mL (range, 400-900 mL). The average follow up was 8.3 years (range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabular protrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no evidence of any loosening or osteolysis on X-rays. There were no other complications recorded.

CONCLUSION: Total hip replacement restores good function to patients suffering from post tubercular arthritis of the hip.

Keywords: Total hip replacement, Cementless hip replacement, Tuberculosis hip, Post-tubercular arthritis hip, Total hip arthroplasty

Core tip: Total hip replacement restores good function to patients suffering from post tubercular arthritis of the hip. A good preoperative work up to rule out any residual disease as well as perioperative chemotherapy are recommended to ensure success. Any recurrence of the disease can be managed by chemotherapy.