Department of Arthritis & Joint Replacement Surgery, Nanavati Super Speciality Hospital, Maharashtra University of Health Sciences, Mumbai, India; Department of Orthopaedics, King Edward Memorial Hospital & Seth G.S. Medical College, Mumbai, India.
Department of Arthritis & Joint Replacement Surgery, Nanavati Super Speciality Hospital, Maharashtra University of Health Sciences, Mumbai, India.
J Arthroplasty. 2021 Mar;36(3):1035-1042. doi: 10.1016/j.arth.2020.09.016. Epub 2020 Oct 1.
The role of total hip arthroplasty (THA) in healed tuberculosis (TB) of the hip has been reported with success in the past. However, the role and success of THA in active TB of the hip has remained controversial.
We retrospectively evaluated a prospective study of 52 THAs done for active TB of the hip in 51 patients. The protocol includes 3-6 months of effective preoperative and 9-18 months postoperative anti-TB therapy. All THAs were performed by the same surgeon (author 1). The selection criteria excluded patients with poor immunity, HIV +ve patient, and presence of discharging sinus. The type of THA implant includes 12 cemented, 38 uncemented, and 2 hybrid fixations.
The mean follow-up was 10.5 years (2-29). Six patients were (6 THAs) lost to follow up after 4 years, including 2 deaths unrelated to TB or THA. There was no reactivation of TB. Mean Harris Hip Score improved from preop 31.77 (20-51) to postop 88 (72-100) in the last follow-up. Two patients had delayed wound healing up to 21 days postop with no evidence of subsequent episode till last follow-up. There was no case of dislocation, neurological complication in any patient. Seven THAs underwent revision for aseptic loosening unrelated to TB.
Single-stage THA is safe in active advanced tubercular arthritic hips with good immunity status under cover of effective anti-TB therapy using strict preop selection protocol.
全髋关节置换术（THA）在过去曾成功应用于愈合性髋关节结核（TB）。然而，THA 在活动性髋关节 TB 中的作用和疗效仍存在争议。
我们回顾性评估了一项前瞻性研究，共纳入 51 例活动性髋关节 TB 患者的 52 例 THA。方案包括术前 3-6 个月和术后 9-18 个月有效的抗结核治疗。所有 THA 均由同一位外科医生（作者 1）完成。选择标准排除了免疫功能差、HIV 阳性和存在窦道的患者。THA 植入物的类型包括 12 例骨水泥固定、38 例非骨水泥固定和 2 例混合固定。
平均随访时间为 10.5 年（2-29 年）。6 例患者（6 例 THA）在 4 年后失访，其中 2 例死亡与 TB 或 THA 无关。无 TB 再激活。末次随访时，Harris 髋关节评分从术前的 31.77（20-51）提高到 88（72-100）。2 例患者术后切口愈合延迟，最长达 21 天，但在末次随访时无后续发作。无脱位或神经并发症发生。7 例 THA 因与 TB 无关的无菌性松动而进行了翻修。
在有效抗结核治疗和严格术前选择方案的情况下，单阶段 THA 治疗具有良好免疫状态的活动性晚期结核性髋关节炎是安全的。
