Leprosy-Induced Hip Arthritis: A Rare Case Report
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Published on: August 4, 2022
Romit Agrawal1, Vijay Singh1, Ayush Sharma1
1Department of Orthopaedic Surgery, Dr. B.R Ambedkar Central Railway Hospital, Byculla, Mumbai, Maharashtra, India.
Introduction:
Leprosy is a chronic granulomatous infection, classically presents with cutaneous and neurological manifestations. Joint involvement in leprosy can present as acute symmetrical or chronic polyarthritis with or without tenosynovitis resembling rheumatoidarthritis.
Case Report:
We report a rare case of lepromatous hip arthritis in a 32-year-old male, known case of leprosytenosynovitis and symmetrical polyarthritis of hands and feet 3 weeks after appearance of typical cutaneous lesion. The patient was started on anti-leprosy and steroid treatment. After 9 months of treatment and recurrent exacerbation of symptoms, the patient developed bilateral hip pain. Hip pain was diagnosed as bilateral avascular necrosis hip on magnetic resonance imaging which progressed to the left hip arthritis later on. The patient underwent staged total hip arthroplasty (THA) for the left hip arthritis, with debridement and antibiotic spacer in the first stage and final hip prosthesis in the second stage.
Conclusions:
Leprosy can present with large joint-like hip involvement including tenosynovitis and acutesymmetrical polyarthritis. Two-stage THA is an alternative treatment option for patients with advanced arthritis of the hip under some difficult conditions. The Harris hip score was increased from 35 preoperatively to 91.5 at the final follow-up.
Insights
Leprosy can cause severe hip arthritis, sometimes mimicking rheumatoid arthritis. This case highlights a rare presentation of lepromatous hip arthritis treated successfully with a two-stage total hip arthroplasty.
Area of Science:
- Rheumatology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Leprosy, a chronic granulomatous infection, typically manifests with skin and nerve issues.
- Joint involvement in leprosy can mimic rheumatoid arthritis, presenting as polyarthritis or tenosynovitis.
Observation:
- A 32-year-old male with known leprosy developed bilateral hip pain 9 months after diagnosis.
- Magnetic resonance imaging revealed bilateral avascular necrosis of the hip, progressing to arthritis in the left hip.
Findings:
- The patient underwent a two-stage total hip arthroplasty (THA) for advanced left hip arthritis.
- Post-surgery, the Harris hip score improved significantly from 35 to 91.5.
Implications:
- Leprosy can manifest with significant large joint involvement, including the hip.
- Two-stage THA offers a viable treatment for advanced leprosy-related hip arthritis in challenging cases.
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