Raja Balgovind S, Ansari Sajid, Yadav Robin, Regmi Anil, Kurmi Arun Chaudhari, Kalia Roop Bhusan
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India.
Indian J Orthop. 2023 Jan 11;57(3):351-370. doi: 10.1007/s43465-023-00817-6. eCollection 2023 Mar.
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.
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.
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).
髋关节结核是一种使人衰弱的疾病，可导致严重的关节破坏，最终引发髋关节疼痛性关节炎。晚期关节炎患者行全髋关节置换术（THA）可提供无痛且活动自如的关节，功能预后良好，但过去由于担心疾病复发，尤其是考虑到疾病活动情况时，THA在结核性髋关节中的某些方面一直存在争议。在为这类病例制定手术计划之前，需要非常仔细地评估各种因素，如手术时机、抗结核治疗（ATT）开始时间、复发、并发症等。
检索了MEDLINE、EMBASE、Cochrane图书馆、Clinicaltrials gov和OpenGrey等电子数据库。使用的关键词有“结核病”“髋关节结核”“髋部结核病”“TB”“THR”“全髋关节置换”“全髋关节成形术”“THA”“强直髋关节”“融合髋关节”“关节固定术”以及布尔运算符“AND”和“OR”。在总共1634篇文章中，选择了38篇进行全文审查，最终22篇文章纳入研究。
对于手术时机，大多数作者依赖于在进行THA之前通过ATT使炎症标志物稳定下来。15位作者主张使用术前ATT，6项研究建议至少进行2周的ATT，3项研究主张术前至少进行3个月的ATT。大多数研究（214髋对18髋）采用一期THA，而非二期或三期手术。在活动性疾病中，72.8%的髋关节使用非骨水泥假体，25.6%的髋关节采用骨水泥固定，1.5%的髋关节采用混合THA固定。总体感染复发率为2.47%。所有作者均报告临床改善情况极佳（平均髋关节Harris评分改善37.17至88.62）。
