Cementless total hip arthroplasty for the management of advanced tuberculous coxitis

Abstract

The question of whether a total joint arthroplasty should be attempted in a patient with a current or previous infection of tuberculosis continues to arouse controversy. The aim of this report was to evaluate the clinical outcomes of cementless total hip arthroplasty for the treatment of advanced tuberculosis of hip. A total of 14 patients with advanced tuberculosis of hip treated by cementless total hip arthroplasty were retrospectively analyzed. For the patients with a definite diagnosis of tuberculosis and elevated levels of CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) before surgery, preoperative antituberculous medications were prescribed for at least 2 weeks. The inflamed soft tissues and destroyed bones were completely curetted out at the time of operation. Twelve of 14 patients received one-stage cementless total hip arthroplasty after a thorough debridement. For the remaining 2 patients, two-stage strategy was taken with cement articulating spacer implanted after a thorough debridement and followed by cementless total hip arthroplasty at 6-8 months later. All patients were prescribed antituberculous medications postoperatively for the first 6 months. The mean Harris Hip Score (HHS) was 36 preoperatively and 87 at the last follow-up. Within an average follow-up period of 49 months (range: 27 - 77), only one patient had reactivation of tuberculosis 7 months after primary THA (total hip arthroplasty) and received resection arthroplasty. Another 13 patients had no reactivation of tuberculosis and revealed stability by bone ingrowth on both socket and femoral stem. Cementless total hip arthroplasty is a safe and effective procedure for advanced tuberculosis of hip. With a thorough debridement followed by a complete course of antituberculous chemotherapy, active tuberculous infection should not be considered a contraindication for THA. In patients whose diagnosis of tuberculosis is confirmed intraoperatively and with no preoperative antituberculous chemotherapy, or in those a thorough debridement can not be achieved, a two-stage surgery may be considered.