[One-stage radical debridement and total hip arthroplasty for treatment of active tuberculosis of the hip].
摘要
OBJECTIVE: To investigate the short-term effectiveness of one-stage radical debridement and total hip arthroplasty (THA) in the treatment of active tuberculosis of the hip. METHODS: Between January 2006 and June 2011, one-stage radical debridement and THA were performed on 12 cases (12 hips) of active tuberculosis of the hip. There were 7 males and 5 females, aged 18-60 years (mean, 46.3 years). The disease duration ranged from 6 to 24 months (mean, 10.5 months). According to Babhulkar and Pande staging criteria, 5 cases were at stage III and 7 cases were at stage IV. One case had sinus, and 2 cases had previous pulmonary tuberculosis. Preoperative hip range of motion was (35.83 ± 9.25) degrees; hip Harris score was 36.83 ± 6.44. Erythrocyte sedimentation rate (ESR) was 45-90 mm/1 h (mean, 62.4 mm/l h); C-reactive protein (CRP) was 19-50 mg/L (mean, 33.6 mg/L). Perioperatively all the patients accepted the regular anti-tuberculous medication. RESULTS: The results of histopathological examination and PCR detection were positive for tuberculosis bacillus. Postoperatively the incisions healed primarily. All the patients were followed up 25-60 months (mean, 40.8 months). The ESR and CRP returned to normal level with no liver injury. Tuberculosis recurrence occurred in 1 patient at 4 months after operation, which was cured after revision. X-ray film showed no prosthesis shift, prosthesis loosening, or sinus tract. At 18-24 months after operation, the bilateral sides had the same bone density, which was similar to that at the final follow-up. Hip range of motion was significantly improved to (107.08 ± 13.56)degrees (t = 14.571, P = 0.000). Hip Harris score was significantly increased to 88.00 ± 10.78 (t = 16.750, P = 0.000). COONCLUSION: A combination of one-stage radical debridement and THA is a safe method to treat active tuberculosis of the hip, which can relief symptoms and improve hip function, with low recurrence and satisfactory short-term effectiveness.