Abstract:

Objective: To evaluate the therapeutic plan and clinical effectiveness of one-stage focal debridement and total hip replacement (THR) in treatment of active hip tuberculosis. Methods: A retrospective analysis was done for 25 cases of active hip tuberculosis who were treated with one-stage focal debridement and THR in Hebei Chest Hospital from June 2015 to June 2018. All patients were treated with anti-tuberculosis chemotherapy regularly for 4-8 weeks (average (6.20±1.22) weeks). The abscess, acetabular sequestra and synovium around the joint were cleared in all operations. The removed normal femoral neck issue were used as implants in area of bone defects and cementless THR as artificial arthroplasty. All cases were confirmed as hip tuberculosis by pathological examination. Anti-tuberculosis treatment were applied for at least 18 months after operations. Operative conditions, healing of lesions, the erythroeyte sedimentation rate (ESR), the C-reactive protein (CRP), position of the prostheses, recovery of hip functions and complications were observed. Results: The follow-up period ranged from 24 to 60 months (average (35.62±8.64) months). The average ESR on 1 d preoperative, 1 month postoperative and at the last time of follow-up were (41.64±12.10) mm/1 h, (23.36±5.87) mm/1 h and (9.88±2.01) mm/1 h, respectively; the average CRP were (43.60±10.35) mg/L, (14.00±3.16) mg/L and (3.80±1.19) mg/L, respectively; the average Harris hip pain scores were 18.40±4.73, 41.68±3.15 and 43.52±1.33, respectively; the average Harris hip total scores were (33.00±6.01), (92.52±3.64), and (97.36±1.80), respectively; The average ESR and CRP on 1 month postoperative and at the last time of follow-up were significantly lower than those on 1 d preoperative (F=103.008, P<0.001; F=270.299, P<0.001). The average Harris hip pain scores and total scores on 1 month postoperative and at the last time of follow-up were significantly improved from 1 d preoperative (F=432.654, P<0.001; F=1832.393, P<0.001). All patients had first intention healing. No deep venous thrombosis, pulmonary embolism, periprostheyic fracture or joint dislocation happened. There were 1 case having incision ruptured into chronic sinus at 6 weeks after surgery, and got lesions healed after dressing and applying ointment for 2 months. Other cases all got recovered with no complications. The joint prosthesis were all well positioned during the follow-up period and no recurrence were observed. Conclusion: Peroperative effective anti-tuberculosis chemotherapy combined with one-stage debridement and THR in treatment of hip joint tuberculosis can significantly decrease hip pain and improve the hip function.

Key words: Tuberculosis,osteoarticular, Arthroplasty,replacement,hip, Therapies,investigational