Outcome of single-stage total hip arthroplasty in advanced active tubercular arthritis of the hip in Indian patients

Abstract

BACKGROUND

Total hip arthroplasty (THA) is an acceptable method of treatment in healed tubercular (TB) arthritis; however, the role of THA remains debatable in advanced active (stage 3 and 4) TB arthritis of the hip (TB hip) in adults. Single-stage THA in advanced active TB hip is fraught with many challenges, including but not limited to disease reactivation, hip instability, and early revision surgery. These complications may lead to suboptimal clinical outcome in the given patient population.

AIM

To investigate the challenges and clinical outcome of single-stage primary THA in advanced active TB hip in Indian adult patients.

METHODS

In this prospective study, 21 Indian adults having advanced active TB hip without active sinus were treated by single-stage primary THA by posterior approach. The minimum duration of preoperative antitubercular treatment was 6 weeks. Tthe type of THA included cemented (n = 18), cementless (n = 2), and hybrid (n = 1). The mean duration of post-operative antitubercular treatment was 15 months. The mean follow-up period was 30 months. Patients were evaluated for disease reactivation, Harris Hip score, implant loosening, and dislocation.

RESULTS

Intraoperative challenges include increased blood loss 465 ± 48 mL (390-510 mL) in all patients, cortical breach of the femur (n = 1), acetabular reconstruction to prevent a high hip center (n = 1), and conversion from cementless to cemented THA (n = 2). Post-operative complications included disease reactivation at 3 months after surgery (n = 1) and hip dislocation with wound dehiscence (n = 1). There was no neurovascular complication. There was no implant loosening at the time of last follow-up. The preoperative mean Harris Hip score showed a statistically significant improvement at the time of final follow-up [27.38 ± 6.3 (range 20-35) vs 78.47 ± 5.24 (range 78-88); P < 0.001].

CONCLUSION

Single-stage primary THA in advanced TB hip is associated with a relatively high rate of complications in certain selected patients.

Keywords: Hip joint; Infection; Tuberculosis; Arthritis; Surgery; Debridement arthroplasty; Dislocation; Hip replacement

Core Tip: Single-stage primary total hip arthroplasty in patients with advanced active tubercular arthritis of the hip (stages 3 and 4) provides a satisfactory outcome in most patients, with a relatively high risk of complications in certain selected cases. Poor compliance with antitubercular treatment is associated with the risk of disease reactivation, despite adequate preoperative antitubercular treatment and the absence of an active discharging sinus.