Functional improvement after hip arthroscopy in cases of active paediatric hip joint tuberculosis: A retrospective comparative study vis-à-vis conservative management

Abstract

PurposeTuberculosis of the hip joint is a significant cause of preventable disability, especially in children. The aim of our study was to evaluate the functional results of hip arthroscopy done in a cohort of patients with hip joint tuberculosis and to compare them with the outcome of conservatively managed cases.MethodsThis was a retrospective cohort study in which we evaluated the records of 22 hip arthroscopies performed in known cases of tuberculosis of the hip joint in children less than 12 years of age. A note of the demographic and clinical parameters like age, duration of symptoms, stage of the disease, time period of follow-up, any complications during surgery, and pre- and post-operative modified Harris hip score (MHHS) was made in all cases. We compared the results with an age-matched cohort of 44 children with hip joint tuberculosis who were treated non-operatively with anti-tuberculosis therapy and traction in the same tertiary care institute.ResultsThe arthroscopic findings in our series included synovitis, chondral erosions of the femoral head and/or acetabulum, pannus formation over the femoral head and/or acetabulum, and labral tears. The various arthroscopic procedures which were done included joint lavage, synovectomy, labral debridement and cheilectomy. The mean follow-up was 45 months, with the minimum being 36 months. There was a statistically significant change in the mean MHHS after hip arthroscopic procedures (p < 0.001); the difference in the mean post- and pre-operative MHHS was independent of age, stage or duration of follow-up. There was a statistically significant difference (p < 0.05) between the magnitude of improvement in MHHS after hip arthroscopy and that after conservative management.ConclusionsArthroscopy of the hip joint in children in cases of tuberculosis can serve as an emerging therapeutic modality. It is an effective and safe minimally invasive procedure, and helps in improving the functional outcome in early disease.

Analysis of the early clinical outcomes of arthroscopic debridement in the treatment of shoulder tuberculosis

“…However, there have been few reports on the treatment of shoulder tuberculosis by arthroscopy. In other joint tuberculosis, the treatment with arthroscopy has achieved good results [19][20][21]. This is similar to the clinical results achieved in this study.…”

Treatment of Stage I-III Hip Joint Tuberculosis With Open Surgical Debridement and Hip Spica in Children: A Retrospective Study

“… 7 , 22 , 23 Moon et al 24 reported open surgical debridement or synovectomy combined with postoperation immobilization to treat pediatric HTB, with a good result of 73.1%. Tiwari et al 25 described hip arthroscopy as an effective and safe minimally invasive procedure in the treatment of pediatric HTB, which seemed to have more advantages in earlier return to activity, less invasive and less perioperative morbidity when compared with the open procedure. They also described the involvement of the labrum under arthroscopy might indicate a poor prognosis.…”

“…The other difference between open surgery and arthroscopy procedure was the use of postoperative spica. After open surgical debridement, some authors recommended a hip spica for 4 to 6 weeks or even several months, which usually was absent for the arthroscopy procedure 24–26…”

Analysis of the Early Clinical Outcomes of Arthroscopic Debridement in the Treatment of Shoulder Tuberculosis

“…However, there have been few reports on the treatment of shoulder tuberculosis by arthroscopy. In other joint tuberculosis, the treatment with arthroscopy has achieved good results [16][17][18] . This is similar to the clinical results achieved in this study.…”