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| CASE REPORT |
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| Year : 1995 | Volume
: 41
| Issue : 4 | Page : 114-6 |
Total hip arthroplasty in healed tuberculous hip.
AS Dogra, SS Kulkarni, PB Bhosale
Department of Orthopaedics, Seth GS Medical College, Parel, Mumbai.
Correspondence Address:
A S Dogra
Department of Orthopaedics, Seth GS Medical College, Parel, Mumbai.
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 0010707737 
Total hip arthroplasty was performed in a patient who had tuberculous hip, quiescent for the last 15 years, without pre or postoperative anti-tuberculous chemotherapy. At a 27 month follow up, there has been no evidence of reactivation. A brief review of relevant literature is also presented.
Keywords: Adult, Arthroplasty, Replacement, Hip, Case Report, Female, Human, Tuberculosis, Osteoarticular, radiography,surgery,
How to cite this article:
Dogra A S, Kulkarni S S, Bhosale P B. Total hip arthroplasty in healed tuberculous hip. J Postgrad Med 1995;41:114 |
A scarcity of reports specifically dealing with total hip arthroplasty for quiescent Tuberculous arthritis of the hip joint[1],[2],[3],[4] exist in literature. Many orthopaedic surgeons are still reluctant to treat quiescent Tuberculous coxitis with total hip arthroplasty because of the risk of reactivation of the disease. We present here a case report with a 27 month follow up with no reactivation.
A thirty-year-old housewife had developed Tuberculous affection of her left hip at the age of 15 years. She had been treated then with a complete course of anti Tuberculous drugs and probably an excision arthroplasty with pelvic support osteotomy (no details of the surgical procedure were available). The patient was asymptomatic for the next 12 years after which she developed, pain and restricted movements of her left hip. She presented to our hospital 3 years after the onset of pain, without any constitutional symptoms. On examination, there was no evidence of active infection. The scar of the previous surgery had healed with primary intention. There was no evidence of healed sinuses. Left hip range of movements were: flexion - 0-90?; abduction-0-20?; adduction - 0-20?; internal rotation 0-10?; external rotation 0-5?. All movements of the hip were extremely painful. There was a true supratrochanteric shortening of 2 cms. Trendelenburg test and telescoping were positive.
Investigations revealed a total WBC count 4600/cu mm (P 62, L 34, E 4), ESR - 2 mm at the end of 1 hour (Westergren). The Chest X-ray showed no evidence of active tuberculosis. X-ray pelvis with both hips is seen in Fig 1. Rest of the biochemical Discussion investigations were normal.
On exploration of the left hip, there was no evidence of active infection or granulation tissue, However, there was abundant fibrosis and soft tissue contracture with a remnant stump of neck being present. The fibrous tissue from the acetabuium was excised and a soft tissue release was done in an attempt to correct the limb length discrepancy. A cemented, low friction, total hip arthroplasty was performed without any intra operative or early postoperative complications. The patient was not started on anti Tuberculous drugs but was given a broad spectrum antibiotic cover for a period of 10 days. At 27 months follow-up, there was no evidence of reactivation of the disease subjectively or objectively. The patient was asymptomatic with a painless range of movement of - flexion -0 -, 901, abduction - 0 - 200 and external rotation - 0 - 300. Abduction and internal rotation were not tested. The patient could perform all daily household activities comfortably. Shortening of 2 cms was corrected with an appropriate heel raise. Roentgenograms [Figure - 2] did not reveal any loosening.
Tuberculous infection of the skeleton has a tendency for chronicity and a total hip arthroplasty has been thought to reactivate the disease[5],[6]. However, a few recent reports[1],[2],[3],[4] have shown good results. Kim et al[1] have suggested that reactivation of tuberculosis occurs due to Immunological impairment and hence a cover of anti Tuberculous drugs is essential. In our case, since there was no clinical, biochemical or radiological evidence of active disease, it was decided not to start anti Tuberculous drugs. Successful total hip arthroplasty without the cover of anti Tuberculous drugs has been reported by Hardinge et al[7]. One of the prerequisites for a successful outcome is a long interval between onset of primary Tuberculous coxitis and the arthroplasty, the recommended lime period being at least 10 years[8]. In our case, the interval was 15 years and there has been no evidence of reactivation over a period of 27 months to date.
| :: References | |  |
| 1. |
Kim YY, Amn BIH, BAE KO, Ko CO, Jung DLL, Byung MK, Yong SY. Arthroplasty using the Charnley prosthesis in old tuberculosis of the hip. Clin Orthop 1986; 211:116-21.  |
| 2. | Kim YY, Haan DY, Park BM. Total hip arthroplasty for Tuberculous coxarthrosis. J Bone Joint Surg 1987; 69-A: 718-27. |
| 3. | Kim YY, Ko CU, Ahn JY, Yoon YS, Kwak BM. Charnley low friction arthroplasty in tuberculosis of the hip. J Bone Joint Surg 1988; 70-13:756-60. |
| 4. | Santavirta S, Eskola A, Kontten YT, Tauroth K. Lindholm ST Total hip arthroplasty in old tuberculosis. A report of 14 cases. Acta Orthop Scand 1988; 59:391-5. |
| 5. | McCullough W. Tuberculosis as a late complication of total hip replacement. Acta Orthop Scand 1977; 48:508-10. |
| 6. | Johnson R, Barnes KL, Owen R. Reactivation of tuberculosis after Total hip Replacement. J Bone Joint Surg 1979; 61-B:148-50. |
| 7. | Hardinge K, Williams, Etienne AA, Mckenzie D, Charnley J. Conversion of fused hips to low friction arthroplasty. J Bone Joint Surg 1977; 59-B:385-92. |
| 8. | Harkess JW. Arthropiasty of Hip in: "Campbell's Operative Orthopaedics", Editor Crenshaw AH; 8th edition. Mosby Year Book, Inc., Missouri 1992; 517.
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Figures
[Figure - 1], [Figure - 2]
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