Total hip replacement for patients with active tuberculosis of the hip

Sj, Kim; Postigo, Ricardo; Koo, Sun Hoe; Kim, Jin‐Hoi

doi:10.1302/0301-620x.95b5.31047

Cited by 25 publications

(15 citation statements)

References 32 publications

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“…Although one-stage THA is considered as a safe procedure for most patients with advanced active TB of the hip by some authors [ 24 ], our practical experience shows that two-stage THA is an alternative option to treat this challenging disease under some difficult conditions. The hip with sinus tracts or destroyed extensively with difficulties of thorough debridement at one operation may be indications of two-stage THA.…”

Section: Resultsmentioning

confidence: 99%

Two-stage total hip arthroplasty for patients with advanced active tuberculosis of the hip

et al. 2016

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BackgroundTreatment of advanced active tuberculosis (TB) of the hip is confronted with great challenges. Although one-stage total hip arthroplasty (THA) is considered as a safe procedure for most patients by some authors, there are still exceptions. The purpose of this paper was to investigate the feasibility and effectiveness of two-stage THA for selected patients with advanced active TB of the hip.MethodsNine consecutive patients with advanced active tuberculous arthritis of the hip were reviewed in this study. Out of these nine patients, the hips of five were destroyed extensively with difficulties of thorough debridement at one operation, and the hips of the other four were detected of sinus tracts. Nine patients received the two-stage total hip arthroplasty (THA) protocol and the perioperative antituberculous medication between January 2008 and December 2013. During the first stage, a debridement was carried out after at least 2 weeks of antituberculous chemotherapy to remove abscesses and infected and necrotic tissues as thoroughly as possible, followed by antituberculous chemotherapy for a minimum of 3 months (average 4.2 months). During the second stage, hip prosthesis was implanted if the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) were normal and the wound was well healed. Antituberculous chemotherapy was continued for 6–9 months postoperatively to constitute a total duration of a minimum of 12 months after the first operation. The patients were then evaluated based on the reactivation of infection, the Harris hip score system, X-ray, ESR, and CRP.ResultsThe average follow-up was 40 months (range, 18–72 months). No reactivation of TB or superimposed infection was observed in all patients. The ESR and CRP returned to the normal level with no liver injury. The average Harris hip score was increased from 35 (range, 15–55) preoperatively to 91.5 (range, 83–97) at the final follow-up. The X-ray film showed no prosthesis shift or loosening.ConclusionsTwo-stage THA is an alternative treatment option for patients with advanced active tuberculosis of the hip under some difficult conditions. The hip with sinus tracts or destroyed extensively with difficulties of thorough debridement at one operation may be regarded as indications.

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Section: Resultsmentioning

confidence: 99%

Two-stage total hip arthroplasty for patients with advanced active tuberculosis of the hip

et al. 2016

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“…Total hip arthroplasty (THA) in the hip with active tuberculous infection is a controversial issue due to the potential risk of reactivation of TB. 26 The acceptability of the THA is gradually increasing globally [Figure 6a and b ] with reports that metal can be safely used in tuberculous lesions. 5 10 THA in a patient with healed TB of the hip is now an accepted procedure 27 28 29 Majority perform it in the stage of the advance arthritis or in sequalae of advance arthritis when the joint is unsalvageable.…”

Section: Aterials and M Ethodsmentioning

confidence: 99%

“… 27 31 Kim et al . 26 evaluated the outcome of THR in patients with active TB of the hip in referenced articles published between 1950 and 2012. A total of 65 patients of histologically confirmed TB were reviewed with a mean followup was 53.2 months (24-108).…”

Section: Aterials and M Ethodsmentioning

confidence: 99%

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Tuberculosis of hip

Saraf

Tuli

2015

IJOO

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Tuberculosis (TB) of the hip is second to spine only hence a good number of cases are visiting the medical facilities every year. Many present in the advanced stage of the disease due to delayed diagnosis. In early stages of TB of hip, there is a diagnostic dilemma when plain X-rays are negative. In the present time, diagnostic modalities have improved from the days when diagnosis was based essentially on clinicoradiological presentation alone. By the time definite radiological changes appear on plain X-ray, the disease has moderately advanced. The modern diagnostic facilities like ultrasonography (USG) or magnetic resonance imaging of the hip joint, USG guided aspiration of synovial fluid and obtaining the material for polymerase chain reaction and tissue diagnosis must be utilized. In the treatment, current emphasis is more on mobility with stability at hip. Joint debridement, skeletal traction, and mobilization exercises may give more satisfying results as compared to the immobilization by hip spica. Adults with advanced arthritis and healed infection should be informed and discussed the various treatment modalities including the joint replacement. More and more surgeons are taking up the challenge of putting the total hip replacement in the active stage of the disease. Until the long term results in active disease are well established, we recommend it for the healed disease only in selected cases.

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“…Sidhu AS et al, 27 Yong qing Wang et al 28 , Kim et al 29 in their respective studies also concluded that THR in patients with active TB of the hip is a safe procedure. If undertaken in association with extensive debridement and appropriate anti-TB treatment, it provides symptomatic relief and functional improvement.…”

Section: Observation and Resultsmentioning

confidence: 95%

Evaluation of pattern and treatment of osteoarticular tuberculosis in central India

Naik¹,

Dulani²,

Khan³

et al. 2020

IJOS

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Introduction: Tuberculosis the global epidemic continues to be a major health problem despite availability of effective chemotherapy. The main aim of the study was to analyse the pattern, clinical findings, diagnosis, and treatment options for osteoarticular tuberculosis at Tertiary care hospital so that proper treatment guidelines can be formulated for the patient. Materials and Methods: A prospective study was performed in the tertiary care. Patients clinically diagnosed as osteoarticular tuberculosis, all the patients who were regular on anti-tubercular treatment and follow-up and all the patients with radiological evidence matching with clinical profile were included in the study. All the patients who showed histopathological evidence in favor of osteoarticular tuberculosis were also included. The patients with only pulmonary tuberculosis, with extra pulmonary involvement, with no osteoarticular involvement were excluded from the study. Observation and Results: The age group of patient ranged from 1-80 years, mean age was 38.11 in males and 34.5 years in females with a total mean age of 36.96 years. Sex predominance was seen in males with 68%. The distribution of the patient according to occupation farmer category showed a maximum of 56%. Socio-economic class distribution according to modified kuppuswamy classification showed most patient belonged to Upper-Lower (IV) 82% and 18% belonged to lower-middle (III) category. Conclusion: Tuberculosis of the spine is still the most preferred site of osteoarticular tuberculosis. Spine patient usually require early surgical intervention especially those with neurological deficits. Outcomes may be maximized through early detection and treatment, although adequate results can still be achieved with salvage procedures in patients presenting with late stages of disease.

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Total hip replacement for patients with active tuberculosis of the hip

Cited by 25 publications

References 32 publications

Two-stage total hip arthroplasty for patients with advanced active tuberculosis of the hip

Two-stage total hip arthroplasty for patients with advanced active tuberculosis of the hip

Tuberculosis of hip

Evaluation of pattern and treatment of osteoarticular tuberculosis in central India

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