Total hip arthroplasty for tuberculous coxarthrosis

Forty-four total hip prostheses were implanted in thirty-eight patients who had tuberculous arthritis of the hip. The interval between active disease and total hip arthroplasty ranged from three months to forty-five years. The length of follow-up averaged 45.6 months (range, twenty-four to eighty-five months). Cultures of material and specimens of tissue that were taken intraoperatively were positive in four hips. The mean functional rating of the hip was 62 points preoperatively and 85 points at final follow-up. Thirty-one patients had a good result; one had to have a revision because of loosening of a component. Six patients had reactivation of the disease that was controlled satisfactorily by chemotherapy alone or in combination with débridement of sinus tracts without removal of the prosthesis. There was a major difference in the percentage of recurrences in patients who had inactive disease for less than ten years (six of fifteen patients) compared with those who had inactive disease for more than ten years (no patients). Total hip arthroplasty appears to be a safe procedure for patients who have quiescent tuberculosis as well as for patients who have active tuberculosis of the hip when there is no gross evidence of active infection.