Is cemented total hip arthroplasty for the treatment of active and advanced tuberculosis of the hip always justified?? A retrospective analysis

Abstract

Background: The dilemma of whether a total hip arthroplasty (THA) should be attempted in a patient with a current or previous tuberculosis infection continues to cause controversy. The goal of this study was to evaluate the clinical result of cemented THA for the treatment of advanced tuberculosis of the hip. Material methods: Ten patients with advanced tuberculosis of the hip treated by cemented THA were retrospectively analyzed. None of the patients had draining sinus preoperatively. In all the patients with a confirmed preoperative diagnosis of tuberculosis and elevated C-reactive protein and erythrocyte sedimentation rate, antituberculous medication was prescribed for at least 4 weeks preoperatively. Inflamed soft tissues and destroyed bones were completely curetted out intraoperatively and tissue sample sent for culture. All 10 patients received 1-stage cemented THA after thorough debridement. Tissue sample which was sent for culture came out to be positive in 5 cases with secondary bacterial infection. Antituberculous medications were prescribed for all patients for the first 6 months postoperatively. Results: 4 out of 10 patients developed wound-healing complications and later discharging sinus. Out of these 4 patients 2 suffered hip dislocation. Mean Harris Hip Score was 35 (range, 30-43) preoperatively and 80 (range, 70-88) at last follow-up. At an average 12 month follow-up (range, 10-18months), no reactivation of tuberculosis was detected but reoperation required in 4 cases which had reactivation or secondary bacterial infection with discharging sinus postoperatively. Conclusion: Cemented THA is a safe and effective procedure for advanced tuberculosis of the hip but it should be always followed after CT guided FNAC of hip joint with negative secondary bacterial culture reports. With thorough debridement followed by a complete course of antituberculous chemotherapy, active tuberculous infection should not be considered a contraindication for THA.