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Treatment of Stage I-III Hip Joint Tuberculosis With Open Surgical Debridement and Hip Spica in Children: A
Lei Yang1, Jingjing Zuo2, Lang Li1
1Department of Pediatric Surgery, West China Hospital, Sichuan University.
Insights
Surgical debridement with hip spica immobilization effectively treats pediatric hip tuberculosis. Prolonged immobilization (6 weeks) did not improve outcomes over shorter periods (4 weeks) and may delay functional recovery in children.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Infectious Diseases
Background:
- Hip joint tuberculosis is a significant pediatric condition requiring effective treatment.
- Conservative management is often the first line of treatment for hip tuberculosis.
- Surgical debridement is considered when conservative measures fail.
Purpose of the Study:
- To evaluate the efficacy of surgical debridement combined with hip spica immobilization for pediatric hip tuberculosis.
- To compare the outcomes of 4-week versus 6-week hip spica immobilization post-surgery.
- To assess the impact of immobilization duration on functional recovery and complications.
Main Methods:
- Retrospective study of 87 children with stage I-III hip joint tuberculosis.
- All patients received initial conservative treatment followed by surgical debridement if needed.
- Patients were divided into two groups: 4-week (Group A) and 6-week (Group B) hip spica immobilization.
- Outcomes assessed included postoperative radiographs, hip stability, and Modified Harris Hip Score (MHHS) at a minimum 5-year follow-up.
Main Results:
- Both 4-week and 6-week immobilization groups showed significant improvement in MHHS post-surgery.
- No significant differences were found between the groups in final MHHS, wound healing delay, or pathological subluxation.
- Group A (4-week immobilization) demonstrated a significantly better early functional outcome after 1 month of exercises compared to Group B (6-week immobilization).
Conclusions:
- Surgical debridement with antitubercular chemotherapy is effective for pediatric hip tuberculosis unresponsive to conservative treatment.
- Prolonged hip spica immobilization (6 weeks) does not offer additional benefits over shorter durations (4 weeks) regarding hip stability or complications.
- Shorter immobilization may lead to faster early functional recovery, suggesting individualized immobilization duration is optimal.
Background:
This study aimed to evaluate the outcome of surgical debridement combined with postoperative hip spica immobilization in the treatment of hip joint tuberculosis in children.
Methods:
This retrospective study enrolled 87 children with stage I to III hip joint tuberculosis treated surgically at our hospital from January 2010 to January 2016. All patients considering hip tuberculosis routinely received a 4-week conservative treatment first, including rest, protected weight-bearing, and 4-drugs antitubercular chemotherapy. Surgical debridement was indicated when there was no relief after this conservative protocol. Patients were divided into 2 groups according to the duration of hip spica immobilization after operation: group A (hip spica for 4 wk, 39 patients) and group B (hip spica for 6 wk, 48 patients). All patients were recommended partial weight-bearing for 7 days and then followed the same hip joint exercises program when spica was removed. Postoperative radiographs, hip dislocation or subluxation, and modified Harris hip score (MHHS) were assessed. All patients were followed up at least 5 years.
Results:
There were 87 patients enrolled in our study, including 34 females and 53 males, with a mean age of 7.2±2.8 years old (range: 2 to 14 y). No significant difference was observed between these 2 groups in baseline data. In group A, the mean MHHS improved from 52.1±14.7 before surgery to 87.8±8.3 at the final follow-up ( P <0.000). In group B, there was also a significant difference between the preoperative MHHS (52.7±9.4) and the final MHHS (88.6±6.5) ( P <0.000). Although there was no significant difference between these 2 groups in the final MHHS ( P =0.593), there were also no significant differences between these 2 groups in wound healing delay (3 in group A and 6 in group B, P =0.705) and pathologic subluxation (3 in group A and 1 in group B, P =0.467). The only difference between group A (79.2±8.5) and group B (75.5±7.5) was the early functional outcome assessed by using MHHS after 1 month of hip joint exercises ( P =0.032).
Conclusions:
Surgical debridement combined with antitubercular chemotherapy is an effective treatment for stage I to III hip tuberculosis in children when there is no improvement after conservative treatment. Prolonged hip spica immobilization may not reduce the risk of hip subluxation after open surgical debridement but could lead to a delay in early functional recovery. Time of spica immobilization should be individualized and based on the surgeon's evaluation and the patient's condition.
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