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Kushwaha NS, Kumar D, Gupta RK, Tewari PG, Singh R, Kumar A. Functional outcome of total hip arthroplasty in tubercular hip arthritis: A prospective study. J Clin Orthop Trauma 2024; 48:102337. [PMID: 38304415 PMCID: PMC10828569 DOI: 10.1016/j.jcot.2024.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
Background Total hip arthroplasty (THA) is a well-established procedure to cure tubercular hip arthritis in patients with healed tuberculosis while its role in active tuberculosis is still debatable. The aim of the study is to investigate the functional outcomes of THA in active tuberculosis with advanced hip arthritis. The reactivation of tuberculosis and complications postoperatively has also been assessed. Materials and methods The current open-ended prospective cohort study was carried out at a tertiary center from 2018 to 2020. Twenty patients of active tubercular hip arthritis (8 females and 12 males) were taken with a follow-up period ranging from 1 year to 3 years, with a mean of 14 months.Biochemical investigations were done both preoperatively and postoperatively. Preoperative anti-tubercular therapy (ATT) regimen was administered, as per standard norms, to patients for a minimum period of 6 weeks, and postoperatively for 6 months-12 months. Postero-lateral and Hardinge approaches were employed in all cases. Clinical and radiological parameters were assessed and functional outcomes were evaluated using the Harris Hip score (HHS). Results The mean age of patients was 37.6 ± 11.38 years. Biochemical parameters were also found to improve postoperatively (p < 0.0001). The mean flexion, extension, abduction, external and internal rotation were found to increase postoperatively (p < 0.001). The mean flexion deformity in the preoperative period was 12.35 ± 4.716, whereas none of the patients had flexion deformities post operatively. The mean shortening was 2.12 ± 0.60 and 1 ± 0 at preoperative and postoperative respectively. The Total hip arthroplasty implant was found stable in all patients. The mean Harris score increased subsequently throughout the follow-up interval and differences were statistically significant (p < 0.0001). None of the patients had reactivation of tuberculosis infection postoperatively. Conclusion Total hip arthroplasty is a reliable option to treat active advanced tubercular hip arthritis and gives good functional outcome with proper preoperative and postoperative ATT regimen.
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Affiliation(s)
- Narendra Singh Kushwaha
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
| | - Dharmendra Kumar
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
| | - Ravindra Kumar Gupta
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
| | - Prakash Gaurav Tewari
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
| | - Riddhi Singh
- Junior Resident, Department of Microbiology, King George's Medical University, Lucknow, UP, India
| | - Ashish Kumar
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
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Viswanathan VK, Patralekh MK, Kalanjiyam GP, Iyengar KP, Jain VK. Total hip arthroplasty in active and advanced tubercular arthritis: a systematic review of the current evidence. INTERNATIONAL ORTHOPAEDICS 2024; 48:79-93. [PMID: 37668728 DOI: 10.1007/s00264-023-05943-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION Total hip arthroplasty (THA) is a well-acknowledged surgical intervention to restore a painless and mobile joint in patients with osteoarticular tubercular arthritis of the hip joint. However, there is still substantial uncertainty about the ideal management, clinical and functional outcomes following THA undertaken in patients with acute Mycobacterium tuberculosis (TB) hip infections. AIM OF THE STUDY To undertake a systematic review and evaluate existing literature on patients undergoing THA for acute mycobacterium tuberculosis arthritis of the hip. METHODS A systematic review of electronic databases of PubMed, EMBASE, Scopus, Web of Science and Cochrane Library was performed on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search focused on "arthroplasty in cases with tuberculosis of hip joint" since inception of databases until July 2023. Data on patient demographics, clinical characteristics, treatment administered, surgical interventions and outcome, as reported in the included studies, were recorded. Median (range) and mean (standard deviation) were used to summarise the data for continuous variables (as reported in the original studies); and frequency/percentage was employed for categorical variables. Available data on Harris hip scores and complications were statistically pooled using random-effects meta-analysis or fixed-effect meta-analysis, as appropriate RESULTS: Among a total of 1695 articles, 15 papers were selected for qualitative summarisation and 12 reporting relevant data were included for proportional meta-analysis. A total of 303 patients (mean age: 34 to 52 years; mean follow-up: 2.5 to 10.5 years) were included in our systematic review. In a majority of included studies, postero-lateral approach and non-cemented prosthesis were employed. Fourteen studies described a single-staged procedure in the absence of sinus, abscess and tubercular infection syndrome (TIS). All surgeries were performed under cover of prolonged course of multi-drug anti-tubercular regimen. The mean Harris hip score (HHS) at final follow-up was 91.36 [95% confidence interval (CI): 89.56-93.16; I2:90.44%; p<0.001]. There were 30 complications amongst 174 (9.9%) patients (95% CI: 0.06-0.13; p=0.14; I2=0%). CONCLUSION THA is a safe and effective surgical intervention in patients with active and advanced TB arthritis of hip. It is recommended that the surgery be performed under cover of multi-drug anti-tubercular regimen. In patients with active sinus tracts, abscesses and TIS, surgery may be accomplished in a multi-staged manner. The clinical (range of motion, deformity correction, walking ability and pain scores), radiological (evidence of radiological reactivation and implant incorporation) and function outcome (as assessed by HHS) significantly improve after THA in these patients.
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Affiliation(s)
| | | | | | - Karthikeyan P Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Vijay Kumar Jain
- Department of Orthopaedics, AtalBihari Vajpayee Institute of Medical Sciences, Dr. Ram ManoharLohia Hospital, New Delhi, 110001, India.
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Arora A, Harna B, Asnake G, Sonkawade V. Total hip arthroplasty in different types of advanced tubercular hip arthritis: is it justified. INTERNATIONAL ORTHOPAEDICS 2023; 47:2669-2681. [PMID: 37453982 DOI: 10.1007/s00264-023-05885-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) provides a good treatment option for the patients in late arthritis stage. We present our experience of THA in various spectrums of disease. METHODS Retrospective study including 23 advanced tubercular hip arthritis patients over a period of 13 years. The patients with active discharging sinus were excluded from the study. The patients were divided into three groups: group 1 (healed TB), group 2 (active TB), and group 3 (intraoperative surprise). The preoperative and postoperative antitubercular treatment (ATT) was administered to all the patients as per the protocol for various duration. All patients underwent THA (cementless or hybrid) after investigations including MRI. The patients were followed up with clinic-radiological and laboratory investigations. RESULTS The mean age of the patients was 58.2 years with 16 males and seven females. There were 14 healed TB hips, eight active TB hips, and one intraoperative TB hip patient. Preoperative ATT duration in group 1 varied from one to two weeks and in group 2 patient's average was 9.6 weeks (range: 6-12weeks). Postoperatively, ATT was given for a minimum of ten months extending to 16 months. Cementless THA was performed in 17 patients and hybrid THA (cemented stem) in six patients. Only one patient had aseptic loosening of the stem and revision arthroplasty was done. CONCLUSION THA is a viable option and provides mobile, stable hip in tubercular hip arthritis even in active TB hip patients. ATT is important in the management and prevent the reactivation of the disease.
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Affiliation(s)
- Anil Arora
- Department of Orthopedics and Joint Replacement, Max Superspeciality Hospital, Patparganj, Delhi, 110092, India
| | - Bushu Harna
- Department of Orthopedics, Indus Hospital, Mohali, India.
| | - Getnet Asnake
- Department of Orthopedics and Joint Replacement, Max Superspeciality Hospital, Patparganj, Delhi, 110092, India
| | - Venktesh Sonkawade
- Department of Orthopedics and Joint Replacement, Max Superspeciality Hospital, Patparganj, Delhi, 110092, India
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Raja BS, Ansari S, Yadav R, Regmi A, Kurmi AC, Kalia RB. Total Hip Replacement in Active and Inactive Tuberculosis Hip: A Systematic Review. Indian J Orthop 2023; 57:351-370. [PMID: 36825271 PMCID: PMC9941390 DOI: 10.1007/s43465-023-00817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Introduction Tuberculosis of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip. Total hip arthroplasty (THA) in patients with advanced arthritis offers a painless and mobile joint with good functional outcome but some aspects of THA in TB hip have been controversial in the past due to the concerns of disease reactivation, especially when disease activity is factored in. Various factors like timing of surgery, Antitubercular therapy (ATT) initiation timing, reactivation, complications etc needs to be evaluated very carefully before planning for such cases. Methods Electronic databases like MEDLINE, EMBASE, Cochrane library, Clinicaltrials gov and OpenGrey were searched. The key words used were "Tuberculosis", "Tuberculosis of hip", Hip tuberculosis, "TB", "THR", "total hip replacement", "total hip arthroplasty","THA", "ankylosed hip", "fused hip", "arthrodesis" along with boolean operators "AND" and "OR". Out of a total of 1634 articles, 38 were selected for full text review and 22 articles were finally included in the study. Results For the timing of surgery most authors relied on the inflammatory markers to settle down with ATT before performing THA. 15 authors advocated use of pre-operative ATT with 6 studies recommending at least 2 weeks and 3 studies advocating atleast 3 months of ATT pre surgery.Single stage THA was performed in most studies(214 hips vs 18 hips) as opposed to 2 or 3 stage surgery. In the active disease 72.8% of the hips had uncemented prosthesis, 25.6% hips underwent cemented and 1.5% hips had hybrid THA fixation. Overall reactivation of the infection was seen in 2.47% cases. All authors reported excellent clinical improvement (mean HHS improvement 37.17 to 88.62).
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Affiliation(s)
- Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Robin Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Anil Regmi
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Arun Chaudhari Kurmi
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Roop Bhusan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
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Zhu RT, Shen LP, Chen LL, Jin G, Jiang HT. One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip: A case report. World J Clin Cases 2021; 9:8587-8594. [PMID: 34754872 PMCID: PMC8554418 DOI: 10.12998/wjcc.v9.i28.8587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/03/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Rang-Teng Zhu
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
- 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
- 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
- Department of Pathology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
| | - Gang Jin
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
- Department of Orthopedics, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
| | - Han-Tao Jiang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
- Department of Orthopedics, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
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Chen C, Yin Y, Xu H, Chen G. Early clinical outcomes of one-stage total hip arthroplasty for the treatment of advanced hip tuberculosis. J Orthop Surg (Hong Kong) 2021; 29:23094990211000143. [PMID: 33745383 DOI: 10.1177/23094990211000143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the clinical efficacy of one-stage total hip arthroplasty (THA) for treating the advanced hip tuberculosis. METHODS A retrospective study was conducted from July 2013 to June 2018, including 19 patients with advanced hip tuberculosis. All patients underwent total hip arthroplasty through posterior approach, and the surgical efficacy was evaluated. RESULTS Nineteen patients were followed up from 24 months to 48 months, the mean follow-up were 32.1 months. All the incisions healed in grade A. There were no aseptic loosening, dislocation or recurrence of hip tuberculosis after operation. At the last follow-up, the Harris score of the patients was (89.3 ± 6.7), which was significantly higher than (38.2 ± 10.5) of the patients before operation (P < 0.05); the flexion-extension range of motion was (93.6° ± 12.1°), which was significantly larger than (38.2° ± 10.5°) of the patients before operation (P < 0.05). CONCLUSION The one-stage total hip arthroplasty with regular antituberculosis treatment can attain satisfactory clinical efficacy in the treatment of advanced hip tuberculosis, which can relieve the joint pain and improve the joint function, without recurrence of hip tuberculosis.
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Affiliation(s)
- Chang Chen
- Department of Orthopaedics, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Yiran Yin
- Department of Orthopaedics, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Huan Xu
- Department of Orthopaedics, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Ge Chen
- Department of Orthopaedics, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
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Gautam D, Jain VK, Iyengar KP, Vaishya R, Malhotra R. Total hip arthroplasty in tubercular arthritis of the hip - Surgical challenges and choice of implants. J Clin Orthop Trauma 2021; 17:214-217. [PMID: 33868917 PMCID: PMC8047221 DOI: 10.1016/j.jcot.2021.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Abstract
Osteoarticular tuberculosis of the hip joint can be a debilitating disease that can result in severe cartilage degeneration, destruction, and eventual painful arthritis of the hip. Usually, a secondary affliction to a primary lung disease, Tuberculosis (TB) of the hip can be difficult to diagnose due to its indolent natural history and deep-seated nature of the hip joint itself. Untreated, ultimately TB hip leads to disabling arthritis of the hip with limitation of activities of daily living, livelihood, and socio-economic consequences. Historic surgical options such as arthrodesis and excision arthroplasty of TB hip have limitations and several disadvantages. Total hip arthroplasty (THA) is a viable option to restore mobility and relieve pain in patients with severe post-tuberculous arthritis but has been controversial in the past due to the concerns of disease reactivation. We evaluate the current role of THA in TB of the hip, its various applications in different presenting scenarios with a guide to surgical tips and tricks for managing this challenging condition.
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Affiliation(s)
- Deepak Gautam
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Vijay K. Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India,Corresponding author.
| | | | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
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