Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8587-8594
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8587
One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip: A case report
Rang-Teng Zhu, Li-Ping Shen, Ling-Lin Chen, Gang Jin, Han-Tao Jiang
Rang-Teng Zhu, Gang Jin, Han-Tao Jiang, Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
Rang-Teng Zhu, Gang Jin, Han-Tao Jiang, Department of Orthopedics, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
Li-Ping Shen, Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
Li-Ping Shen, Clinical Laboratory, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
Ling-Lin Chen, Department of Pathology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
Ling-Lin Chen, Department of Pathology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
Author contributions: Zhu RT performed the surgery and wrote the manuscript; Shen LP performed the laboratory tests on the patient; Chen LL performed the pathological examination on the patient; Jin G followed up the patient and prepared the manuscript; Jiang HT contributed to the conception of the study.
Supported by Basic Public Welfare Research Project of Zhejiang Province, No. GF20H200021; and Luqiao Science and Technology Bureau Foundation, No. 2019A23005.
Informed consent statement: The informed consent was obtained from the patient.
Conflict-of-interest statement: We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Han-Tao Jiang, MA, Attending Doctor, Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, Taizhou 317000, Zhejiang Province, China. jianght5652@enzemed.com
Received: May 25, 2021
Peer-review started: May 25, 2021
First decision: June 25, 2021
Revised: July 3, 2021
Accepted: August 12, 2021
Article in press: August 12, 2021
Published online: October 6, 2021
Processing time: 125 Days and 18.2 Hours
Abstract
BACKGROUND

A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip (DDH) and a drainage sinus is a rare condition. There are no previous reports of this condition, and it is a complex challenge for surgeons to develop a treatment scheme.

CASE SUMMARY

We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month. Approximately 40 years ago, a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy. After the sinus healed, gradual pain occurred in the left hip for 40 years. Approximately one month prior, hip pain was sharply aggravated, and a drainage sinus reoccurred in the left hip. The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur, as well as an acetabular deformity. The results of Mycobacterium tuberculosis antibody and Xpert were positive. Therefore, the patient was diagnosed with advanced TH combined with Crowe type IV DDH. After 22 d of treatment with anti-tuberculosis chemotherapy, the sinus healed, and the patient underwent one-stage total hip arthroplasty (THA) surgery consisting of debridement, osteotomy, and joint replacement. After surgery, the patient received anti-tuberculosis chemotherapy drugs for nine months, with no recurrent infection. After one year of follow-up, the Harris score of the patient increased from 21 pre-THA to 86.

CONCLUSION

Although drainage sinuses are a contraindication to one-stage THA, one-stage THA is still an effective and safe surgical method after the sinus heals.

Keywords: Advanced tuberculosis of the hip joint; Developmental dysplasia of the hip; Total hip arthroplasty; Drainage sinus; Anti-tuberculosis treatment; Case report

Core Tip: We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month. The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur, as well as an acetabular deformity. The results of Mycobacterium tuberculosis antibody and Xpert were positive. Therefore, the patient was diagnosed with advanced tuberculosis hip combined with Crowe type IV Developmental dysplasia of the hip. After 22 d of treatment with anti-tuberculosis chemotherapy, the sinus healed, and the patient underwent one-stage total hip arthroplasty surgery. After surgery, the patient received anti-tuberculosis chemotherapy drugs for nine months, with no recurrent infection.