Single stage total hip replacement in active tuberculosis of hip: A systematic review and meta-analysis

Total hip replacement (THR) in the tuberculous (TB) hip joint can be done in the same sitting or in a staged manner. The study aimed to analyse evidence within the current literature on single-stage THR in active TB hip in terms of duration and regimen of anti-tubercular treatment (ATT), timing of surgery, approach to hip, additional surgical procedures done, implants used, complications and outcomes. Articles were searched according to Preferred Items for Systematic Reviews and Mata Analysis (PRISMA) format. The inclusion criteria for the articles were 1) original articles reporting the outcomes of arthroplasty in active TB hip joint, 2) reporting the timing of ATT with regards to the surgery and 3) follow up more than 2 years. Post-operative ATT was continued in all the studies for a period ranging from 9 to 18 months. The mean postoperative Harris Hip Score (HHS) of all the studies was more than 80, signifying good functional improvement. Earlier concern regarding the worsening of disease condition seems misplaced with the current evidence. Ceramic implants are preferred for THR due to their improved longevity. There is objective improvement in the function of the joint, after surgery. Adequate ATT and debridement from an inalienable part of one-stage THR in TB hip joint and post-operative ATT for at least 12 months or more depending on the inflammatory signs and markers are advised for successful outcomes.