[Total hip replacement after tuberculous coxitis. Twenty-seven-year experience (1980-2007)]

Tuberculous hip arthritis accounts for about 15 % of all orthopaedic forms of tuberculosis and ranks third after spinal and knee joint tuberculosis. The aim of this study was to present the results of total hip arthroplasty (THA) for treatment of post-infectious arthritis or ankylosis, or previous arthrodesis.

A group of patients, 16 women and 10 men, treated at the 1st Department of Orthopaedics, 1st Faculty of Medicine, Charles University in Prague, between 1980 and 2007, was evaluated. All patients had tuberculous hip arthritis in their history and subsequently underwent THA. The average age at the time of THA was 65 years.

Indications for THA following tuberculous coxitis were secondary post-infectious arthritis in 20 patient, ankylosis (fibrous or osseous) in four and conversion from arthrodesis in two. Intra-operative samples were taken for microbiological examination, polymerase chain reaction (PCR) and histological examination. Anti-tuberculous drugs (rifampicin and isoniazid) and cephalosporin were administered intra-operatively following the sample collection and continued post-operatively. Cephalosporin was discontinued on post-operative day 11, rifampicin and isoniazid were administered for further 3 to 5 months with regular laboratory tests.

The average post-operative values for flexion ranged from 0 to 90 degrees, for abduction from 0 to 35 degrees and for both internal and external rotation from 0 to 30 degrees. At the end of treatment all patients walked without aid and with full weight-bearing on the operated leg. No complications were recorded. Intra-operative findings of microbiological, PCR and histological examinations were negative. No recurrent tuberculous disease was found.

A total joint replacement in any post-infectious condition is a complex issue. The average time between achieving a steady state o tuberculous arthritis and the THA procedure was approximately seven years. The outcome was evaluated as good by 75 % of the patients, who would be willing to undergo the surgery again. The clinical picture and radiographic and laboratory findings were within norms at regular follow-ups, which is in agreement with the literature data. Our system of intra- and post-operative administration of anti-tuberculous drugs and antibiotics proved very efficient.

In contrast to arthrodesis or Girdlestone resection arthroplasty, THA results in a marked improvement of painless joint motion. Before any patient is indicated for THA, a thorough medical history with laboratory, internal and pulmonary (including heart and lung radiographs) examination is necessary. When there is more than one tuberculous disease in the patient's medical history, other organ systems such as urinary or reproductive tracts should also be examined. In addition to conventional radiography, examination by computed tomography or magnetic resonance imaging is indicated. The priority is an individual approach of the phthisiology orthopaedist to the indications ensuing from this comprehensive examination, with assessment of both physical and psychic state of the patient in view of post-operative rehabilitation.