From the Research
Total hip replacement (THR) can be performed in patients with tubercular hip disease, but it requires careful consideration and management, with the most recent and highest quality study suggesting that THR is an effective method for treating tubercular arthritis of the hip, significantly improving patients' quality of life 1.
Key Considerations
- The procedure is generally recommended after the tuberculosis infection has been adequately treated with anti-tubercular therapy for at least 3-4 weeks before surgery, though ideally the full course of anti-tubercular treatment (typically 6-12 months) should be completed.
- The standard anti-tubercular regimen includes isoniazid, rifampicin, ethambutol, and pyrazinamide for the initial 2 months, followed by isoniazid and rifampicin for the continuation phase, as outlined in recent updates on tuberculosis treatment 2.
- During surgery, thorough debridement of all infected and necrotic tissue is essential, and samples should be sent for histopathology and culture to confirm the absence of active infection.
- Postoperatively, anti-tubercular therapy should be continued to complete the full treatment course.
Surgical Approach and Outcomes
- Single-stage surgery is commonly used, but two-stage surgery can be considered in complex patients at greater risk 1.
- Cementless prostheses are preferred over cemented prostheses, with hybrid fixation used in a small percentage of cases.
- The lateral and posterior approaches are dominant in the included studies.
- The average complication rate is 11.2%, with disease reactivation occurring in 34 patients across the studies.
- The mean Harris hip score (HHS) at the final follow-up is 89.05, indicating significant improvement in joint function and quality of life.
Recommendations
- THR is an effective method for treating tubercular arthritis of the hip, but requires careful consideration and management to minimize the risk of postoperative complications.
- A long course of multidrug antituberculosis therapy is crucial for preventing reactivation and enhancing the effectiveness of surgery.
- Close follow-up is necessary to monitor for any signs of reactivation or complications, with a focus on improving joint function and quality of life in patients with severe joint destruction.