Total Hip Replacement in Active and Inactive Tuberculosis Hip: A Systematic Review

Area of Science:

• Orthopedics
• Infectious Diseases
• Surgical Innovation

Background:

• Hip tuberculosis (TB) can lead to severe joint destruction and debilitating arthritis.
• Total hip arthroplasty (THA) offers pain relief and improved function but carries concerns of TB reactivation.
• Careful consideration of surgical timing and anti-tubercular therapy (ATT) is crucial for successful THA in hip TB.

Purpose of the Study:

• To review the current literature on total hip arthroplasty (THA) for hip tuberculosis.
• To evaluate factors influencing THA outcomes in hip TB, including timing of surgery and ATT.
• To assess the incidence of disease reactivation and clinical improvements following THA for hip TB.

Main Methods:

• A systematic literature search was conducted across multiple electronic databases (MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, OpenGrey).
• Keywords included "Tuberculosis", "Hip tuberculosis", "Total hip arthroplasty", and related terms.
• 22 articles were selected for final analysis from an initial pool of 1634 studies.

Main Results:

• Most studies recommended waiting for inflammatory markers to normalize with ATT before THA, with many advocating pre-operative ATT (2 weeks to 3 months).
• Single-stage THA was predominantly performed (214 hips vs. 18 hips for multi-stage).
• Reactivation of infection occurred in 2.47% of cases, with excellent clinical improvement reported (mean HHS increase from 37.17 to 88.62).

Conclusions:

• Pre-operative anti-tubercular therapy and single-stage total hip arthroplasty are generally favored for hip tuberculosis.
• THA demonstrates favorable outcomes and low reactivation rates in carefully selected hip TB patients.
• Optimizing ATT and surgical timing is key to successful THA in hip tuberculosis.