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Total hip arthroplasty in active and advanced tubercular arthritis: a systematic review of the current evidence

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Abstract

Study design

Systematic review.

Introduction

Total hip arthroplasty (THA) is a well-acknowledged surgical intervention to restore a painless and mobile joint in patients with osteoarticular tubercular arthritis of the hip joint. However, there is still substantial uncertainty about the ideal management, clinical and functional outcomes following THA undertaken in patients with acute Mycobacterium tuberculosis (TB) hip infections.

Aim of the study

To undertake a systematic review and evaluate existing literature on patients undergoing THA for acute mycobacterium tuberculosis arthritis of the hip.

Methods

A systematic review of electronic databases of PubMed, EMBASE, Scopus, Web of Science and Cochrane Library was performed on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search focused on “arthroplasty in cases with tuberculosis of hip joint” since inception of databases until July 2023. Data on patient demographics, clinical characteristics, treatment administered, surgical interventions and outcome, as reported in the included studies, were recorded. Median (range) and mean (standard deviation) were used to summarise the data for continuous variables (as reported in the original studies); and frequency/percentage was employed for categorical variables. Available data on Harris hip scores and complications were statistically pooled using random-effects meta-analysis or fixed-effect meta-analysis, as appropriate

Results

Among a total of 1695 articles, 15 papers were selected for qualitative summarisation and 12 reporting relevant data were included for proportional meta-analysis. A total of 303 patients (mean age: 34 to 52 years; mean follow-up: 2.5 to 10.5 years) were included in our systematic review. In a majority of included studies, postero-lateral approach and non-cemented prosthesis were employed. Fourteen studies described a single-staged procedure in the absence of sinus, abscess and tubercular infection syndrome (TIS). All surgeries were performed under cover of prolonged course of multi-drug anti-tubercular regimen. The mean Harris hip score (HHS) at final follow-up was 91.36 [95% confidence interval (CI): 89.56–93.16; I2:90.44%; p<0.001]. There were 30 complications amongst 174 (9.9%) patients (95% CI: 0.06–0.13; p=0.14; I2=0%).

Conclusion

THA is a safe and effective surgical intervention in patients with active and advanced TB arthritis of hip. It is recommended that the surgery be performed under cover of multi-drug anti-tubercular regimen. In patients with active sinus tracts, abscesses and TIS, surgery may be accomplished in a multi-staged manner. The clinical (range of motion, deformity correction, walking ability and pain scores), radiological (evidence of radiological reactivation and implant incorporation) and function outcome (as assessed by HHS) significantly improve after THA in these patients.

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Author information

Authors and Affiliations

  1. Department of Orthopedics, University of Calgary, Calgary, Alberta, Canada

    Vibhu Krishnan Viswanathan

  2. Central Institute of Orthopaedics, Safdarjung Hospital New Delhi, New Delhi, India

    Mohit Kumar Patralekh

  3. Ganga Medical Center and Hospital, Coimbatore, Tamil Nadu, India

    Guna Pratheep Kalanjiyam

  4. Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK

    Karthikeyan P. Iyengar

  5. Department of Orthopaedics, AtalBihari Vajpayee Institute of Medical Sciences, Dr. Ram ManoharLohia Hospital, New Delhi, 110001, India

    Vijay Kumar Jain

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  1. Vibhu Krishnan Viswanathan
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Contributions

Vibhu Krishnan Viswanathan: methodology, formal analysis and investigation, writing—original draft preparation. Mohit Kumar Patralekh: conceptualization, methodology, formal analysis and investigation, resources. Guna Pratheep Kalanjiyam: methodology, formal analysis, and investigation. Karthikeyan P Iyengar: conceptualization, methodology, writing—review and editing. Vijay Kumar Jain: conceptualization, methodology, writing—review and editing, resources, supervision.

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Correspondence to Vijay Kumar Jain.

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Viswanathan, V.K., Patralekh, M.K., Kalanjiyam, G.P. et al. Total hip arthroplasty in active and advanced tubercular arthritis: a systematic review of the current evidence. International Orthopaedics (SICOT) 48, 79–93 (2024). https://doi.org/10.1007/s00264-023-05943-2

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