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

Table 1 Exclusion criteria for study participants

Exclusion criteria
Skeletally immature patient	Immunocompromised status of patients
Stage 1 and 2 involvement of TB hip	Presence of an active discharging sinus
Refused for a surgical intervention due to financial constraints	Revision total hip arthroplasty for tubercular arthritis of the hip
Short follow-up

TB hip: Tubercular arthritis of the hip.

Table 2 Investigations to make preoperative diagnosis of tubercular arthritis of the hip

Preoperative diagnostic work-up
Thorough clinical history and examination
Radiological examination
Radiographs of the pelvis with both hips, AP view as well as lateral; view of the involved hip; chest X-rays, PA view
MRI pelvis
Complete blood count, ESR, CRP
USG guided hip aspiration-aspirate sent for CBNAAT, Gram staining, culture, and sensitivity for tubercle bacilli in selected cases

AP: Anteroposterior view; CBNAAT: Cartridge-based nucleic acid amplification test; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; MRI: Magnetic resonance imaging; PA: Posteroanterior view; USG: Ultrasonography.

Table 3 Comparison of mean Harris Hip score, C-reactive protein, and erythrocyte sedimentation rate. Mean preoperative values are compared with mean values at 6 weeks, 12 weeks, 24 weeks, 48 weeks, and 72 weeks follow-up interval

Parameter	Pre-operative vs 6 weeks		Pre-operative vs 12 weeks		Pre-operative vs 24 weeks		Pre-operative vs 48 weeks		Pre-operative vs 72 weeks
	Difference between means	P value	Difference between means	P value	Difference between means	P value	Difference between means	P value	Difference between means	P value
HHS	35.61	< 0.04	43.38	< 0.05	49.46	< 0.01	51.53	< 0.01	52.69	< 0.001
ESR	-40.60	< 0.03	-39.7	< 0.04	-43.39	< 0.01	-44.31	< 0.01	-45.47	< 0.001
CRP	-28.29	< 0.02	-30.31	< 0.05	-32.92	< 0.01	-33.31	< 0.01	-34.21	< 0.001

CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; HHS: Harris Hip score.

Table 4 Prevalence of co-morbidities in the study populations

Co-morbidities	Number of patients	Pharmacological treatment	Influence on outcome
Hypothyroidism	1	Tablet thyroxine	No effect
Hypertension	1	Tablet amlodipine	No effect
Asthma	1	Salbutamol respules (on and off)	No effect
PCOD	1	Metformin	No effect
Diabetes mellitus	2	Glimepiride, metformin, and insulin	Drug interaction with ATT had indirect effect on dose adjustment. But no effect on outcome

ATT: Antitubercular treatment; PCOD: Polycystic Ovarian Disease.

Table 5 Comparison of our study with other similar studies in terms of type of arthroplasty, stage of surgery and revision surgery

Ref.	Follow up period	Type of arthroplasty	Single vs two stages	Revision surgery	Limitation of study	Direction for future research
Our study	18 months	Cemented/uncemented/hybrid	Single stage	0	Relatively short period of follow-up	Long follow-up is required to comment upon implant longevity
Yoon et al[15]	4.8 years	Cementless	Single stage	0	Retrospective analysis of seven patients	Prospective study with a greater number of patients is desirable
Wang et al[35]	49 months	Cementless/cemented	Single stage	0
Bhosale et al[33]	10.5 years	Cemented/cementless/hybrid	-	7 aseptic loosening	Although patients were evaluated in two phases, there is no patient with an active sinus	A comparative study with and without an active sinus will clarify the impact of sinus on disease recurrence
Zhang et al[44]	41.6 months	-	1/2/3 stage	0	Type of arthroplasty not mentioned	Type of THA (cemented vs cementless) should be clearly mentioned

THA: Total hip arthroplasty.

Table 6 Incidence of disease reactivation compared with other similar studies

Ref.	Follow-up	Disease reactivation	Study limitation	Direction for future research
Our study	18 months	1	Advance work-up to rule out pulmonary tuberculosis was not done	Co-existing pulmonary TB should be effectively ruled out
Neogi et al[34], 2010	41 months	1	Retrospective case series. Cause of reactivation not mentioned	A prospective study with detailed work-up of the cause of disease reactivation is needed
Wang et al[35], 2010	49 months	0	Retrospective study with small sample size	Prospective study with larger sample size would be more helpful to generalize the study outcome
Bhosale et al[33], 2020	10.5 years	0	Retrospective case series, includes only patient without an active sinus. Exact duration of disease not mentioned	Prospective study including patients with active sinus would better help to assess the impact of sinus on disease recurrence
Chen et al[43], 2021	32.1 months	Aseptic loosening = 0; dislocation = 0; recurrence = 0	Retrospective study, duration of disease highly variable (9 months to 12 years)	Prospective study with lesser variation in duration of disease will be more useful
Kushwaha et al[31], 2024	14 months	0	Short follow-up period	A longer follow-up period will be more helpful in assessing implant longevity

TB: Tuberculosis.