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One-stage focal debridement and total hip replacement for active tuberculosis: a report of 28 cases

Objective To evaluate the feasibility and clinical efficacy of one-stage focal debridement and total hip replacement (THR) in treatment of active tuberculosis of the hip.Methods A retrospective analysis was done for 28 cases of active hip tuberculosis who were treated with one-stage focal debridement and THR in our hospital from January 2007 to October 2010.There were 17 males and 11 females,with an average age of 36 years (range,18-72 years).Eight patients had abscess only inside the joint,while 20 also had periarticular abscess.All patients had acetabular and femoral head damage.The erythrocyte sedimentation rate (ESR) before operation averaged 52 mm/l h (range,28-102 mm/lh),and the C-reactive protein (CRP) averaged 38 mg/L (range,11 to 73 mg/L).The anti-tuberculous treatment before operation lasted 7 weeks in average (range,3-32 weeks).The abscess and acetabular sequestra around the joint were cleared in all operations.The removed femoral head and neck issue were cleared from focus,soaked in 75％ alcohol for 5 min,washed with saline,and used as implant in area of bone defect.Cementless THR was performed.All cases were confirmed as hip tuberculosis by pathological examination.Anti-tuberculous treatment was applied for 18 months after operation.Results All of 28 patients were followed up for an average of 37 months (range,24-56 months).All patients had first intention healing.ESR returned to normal in an average of 3.3 months (range,2-5 months),and CRP 2.1 months (range,1-3 months).The Harris hip score improved from 30.214±9.350 preoperatively to 90.535±6.746 postoperatively.One patient stopped anti-tuberculosis chemotherapy 13 months after operation at his own choice,and relapsed.He was able to walk 56 months after operation,and no loosening was observed in the hip stem or acetabular cup.The patient has the prosthesis retained and is under close follow-up.Conclusion It is reliable to use one-stage focal debridement and THR based on effective anti-tuberculous chemotherapy to treat active tuberculosis of the hip. 
 
Key words: 
Hip joint;  Tuberculosis, osteoarticular;  Arthroplasty, replacement, hip