Long Term Clinical Effect Of The Artificial Joint Replacement In Treatment Of Active Tuberculosis Of The Hip

Objective:To evaluate the feasibility and clinical efficacy of total hip replacement(THR) in treatment of active tuberculosis of the hip. Methods: A retrospective analysis was done for 8 eases of active hip tuberculosis who were treated with 1st THR in our hospital from January 2006 to January 2012. There were 5males and 3 female with an average age of 50 years(range,20-70 years). 3 patients had abscess only inside the joint,while 5 also had periarticular abscess. All patients had acetabular and femoral head damage. The erythrocyte sed-imentation rate(ESR) before operation averaged72mm/h(range,50-95mm/h),and the C-reactive protein(CRP) averaged 53mg/L(range,40-72 mg/L). The anti-tuberculous treatment before operation lasted 3 weeks in average(range,2-5 weeks). The abscess and acetabular sequestra around the joint were cleared in all operations. Cementless THR was performed. All cases were confirmed as hip tuberculosis by clinical performance expression in operations pathological and laboratory examination. Anti-tuberculous treatment was applied for 12-18 months after operation. Results:A11 of 8 patients were followed up for an average of 6.4years(range,3-10 years). All patients had primary healing.ESR returned to normal in an average of 4.2 months(range,2-7 months), and CRP 2.4 months(range, 1-4 months). The Harris hip score improved from 32.0±2.5 preoperatively to 90.4±5.7 postoperatively. One patient stopped anti-tuberculosis chemotherapy at his own choice because of gastrointestinal reaction, and relapsed. He was able to walk only 500 meters 7 years after operation, and no loosening was observed in the hip stem or acetabular cup. The patient is remain under close follow-up. Conclusion: It is reliable to use 1st or 2nd stage THR based on effective anti-tuberculous chemotherapy to treat active tuberculosis of the hip.