Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2015; 6(2): 316-321
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.316
Total hip arthroplasty for surgical management of advanced tuberculous hip arthritis: Case report
Shi Ming Tan, Pak Lin Chin
Shi Ming Tan, Pak Lin Chin, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169865, Singapore
Author contributions: Tan SM and Chin PL designed the report; Tan SM collected the patient’s clinical data and imaging; Chin PL performed the surgery for the patient; Tan SM and Chin PL analyzed the data and wrote the paper.
Supported by Department of Orthopaedic Surgery, Singapore General Hospital.
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: Shi Ming Tan, MBBS (Singapore), MRCS (Edinburgh), Resident, Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865, Singapore. tshiming@hotmail.com
Telephone: +65-97380973 Fax: +65-62249221
Received: May 20, 2014
Peer-review started: May 20, 2014
First decision: July 18, 2014
Revised: November 10, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: March 18, 2015
Abstract

Tuberculosis (TB) arthritis of the hip is a debilitating disease that often results in severe cartilage destruction and degeneration of the hip. In advanced cases, arthrodesis of the hip confers benefits to the young, high-demand and active patient. However, many of these patients go on to develop degenerative arthritis of the spine, ipsilateral knee and contralateral hip, necessitating the need for a conversion to total hip arthroplasty. Conversion of a previously fused hip to a total hip arthroplasty presents as a surgical challenge due to altered anatomy, muscle atrophy, previous surgery and implants, neighbouring joint arthritis and limb length discrepancy. We report a case of advanced TB arthritis of the hip joint in a middle-aged Singaporean Chinese gentleman with a significant past medical history of miliary tuberculosis and previous hip arthrodesis. Considerations in pre-operative planning, surgical approaches and potential pitfalls are discussed and the operative technique utilized and post-operative rehabilitative regime of this patient is described. This case highlights the necessity of pre-operative planning and the operative technique used in the conversion of a previous hip arthrodesis to a total hip arthroplasty in a case of TB hip arthritis.

Keywords: Tuberculosis, Arthritis, Arthroplasty, Conversion, Arthrodesis

Core tip: Different technical considerations regarding treatment of tuberculosis (TB) hip arthritis and various surgical techniques have been used in the surgical management of TB arthritis. This case report clearly illustrates the pre-operative planning, technical considerations and surgical technique used in the conversion of a arthrodesis into a total hip arthroplasty.