Total hip replacement prosthesis infected by Mycobacterium tuberculous

We examined the diagnostic and therapeutic approaches used for two patients with loosened total hip prostheses who developed Mycobacterium tuberculosis infection. Revision total hip arthroplasty (THA) was performed in one patient. The prosthesis was left in situ in the second patient due to lack of sufficient bone stock. Medical treatment was given. The diagnosis was established on direct examination of bacteriological samples and culture on specific media. Polymerase chain reaction identified the Mycobacterium tuberculosis complex. Non-specific granulomas were observed on the histology sections. For us, management of overt tuberculosis involving a THA depends on the quality of the fixation. If the prosthesis remains stable, medical treatment can be sufficient. If the prosthesis loosens, definitive ablation must be considered with possible revision THA later. Exceptionally, a loosened implant may be left in situ if the remaining bone stock is insufficient. Minimal duration of anti-tuberulosis treatment is six months.     

Total hip replacement in tuberculosis of hip: A systematic review

Total hip replacement (THR) in patients with tuberculous arthritis of the hip is controversial. The timing of surgery, type of prosthesis, reactivation of the disease, high complication rates and the long-term survival of the reconstruction are the major conc erns. There is little information regarding this concern in the literature. We conducted a systematic review of published studies on Total Hip Replacement in patients with Tuberculosis of the hip. A search of Pubmed and Google Scholar database articles published between January 2000 and July 2017 was performed. Thirteen articles were identified, comprising 226 patients. The mean follow-up was 5.48 years. Antituberculosis treatment was given for atleast 2 weeks pre-operatively and continued post-operatively for between six and 18 months after THR. Three patients had reactivation of infection. At the final follow-up, the mean Harris hip score was 89.98. Total Hip Replacement in tuberculosis of hip is safe and efficient way to save the joint function. The most important factors to achieve success include the accurate diagnosis, efficient pre- and postoperative anti-tuberculosis therapy, thorough debridement, two stage procedure for patients with sinus(es).     

Total hip replacement in old tuberculosis. A report of 14 cases

We treated 14 patients with a cemented total hip replacement for old tuberculosis on an average 43 years after the onset of the coxitis. Nine patients were not given any antituberculous treatment, whereas in 5 patients treatment with antituberculous drugs was administered postoperatively for 6 to 12 months. The duration of postoperative follow-up was on an average 8 (5-10) years. Using the Mayo hip scoring system, 8 of the patients were classified as excellent or good, 3 as fair, and 3 as poor. The poor results were in 2 cases due to aseptic loosening of the prosthesis and infection in 1. None of the patients showed reactivation of the tuberculosis.     

Deep sepsis from Mycobacterium tuberculosis after total hip replacement. Case report

One case of deep sepsis from Mycobacterium tuberculosis occurring two years after total hip replacement is reported. The patient had no history of previous tuberculous infection nor showed any sign of systemic disease at the time of surgery. The clinical and pathogenic implications are discussed.     

Total hip replacement in old tuberculosis: A report of 14 cases

We treated 14 patients with a cemented total hip replacement for old tuberculosis on an average 43 years after the onset of the coxitis. Nine patients were not given any antituberculous treatment, whereas in 5 patients treatment with antituberculous drugs was administered postoperatively for 6 to 12 months. The duration of postoperative follow-up was on an average 8 (5-10) years. Using the Mayo hip scoring system, 8 of the patients were classified as excellent or good, 3 as fair, and 3 as poor. The poor results were in 2 cases due to aseptic loosening of the prosthesis and infection in 1. None of the patients showed reactivation of the tuberculosis.     

Late recurrence of Mycobacterium bovis genitourinary tuberculosis: case report and review of literature

A patient is described in whom Mycobacterium bovis genitourinary tuberculosis occurred initially 25 years after childhood scrofula and then recurred 29 years later despite apparently successful therapy. A review of the literature indicated that this 29-year interval between successive bouts of clinical genitourinary tuberculosis is among the longest described. This case also is a reminder that, although rare, Mycobacterium bovis infection and genitourinary tuberculosis still occur. To avoid nonrecognition of this disease and its potentially serious consequences, clinicians should remain vigilant for tuberculosis even in unusual clinical circumstances.     

Total hip replacement for arthritis following tuberculosis of hip

AIM: To present the results of total hip arthroplasty (THA) for post tubercular arthritis of the hip joint.METHODS: Sixty-five patients (45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years (range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction (PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also recorded.RESULTS: The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years (range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min (range, 65-125) whereas the mean blood loss was 600 mL (range, 400-900 mL). The average follow up was 8.3 years (range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabular protrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no evidence of any loosening or osteolysis on X-rays. There were no other complications recorded.CONCLUSION: Total hip replacement restores good function to patients suffering from post tubercular arthritis of the hip.     

Total hip replacement fifteen years after pelvic support osteotomy (PSO): a case report and review of the literature

Treatment of chronic hip instability in children and young adults is challenging. Proximal femoral osteotomy had been suggested to provide pelvic stability and improved abductor function. Total hip replacement after pelvic support osteotomy can be challenging due to altered anatomy due to angulation of the proximal femur in both frontal and sagittal planes. This is a 29-year-old woman who had total hip replacement after pelvic support osteotomy. The patient had pelvic support at the age of 14 years. Pelvic support osteotomy delayed the need for total hip replacement for 15 years. Preoperative planning for total hip replacement with model was used for proper understanding of the anatomy of the proximal femur. Revision of femoral component was necessary due to penetration of the proximal femur. In conclusion, total hip replacement after pelvic support osteotomy is a technically demanding procedure, and careful attention to surgical details is necessary for successful outcome.     

Early sarcomatous degeneration near a cementless hip replacement. A case report and review.

We present the case of a 65-year-old man who developed a malignant fibrous histiocytoma at the lesser trochanter five months after a cementless hip replacement. We have reviewed reports of similar cases and discuss them in terms of the possible mechanisms of sarcomatous degeneration and the latency of such changes.     

Total hip arthroplasty in dwarfism. A case report

In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early age. In these patients a joint replacement is a demanding procedure due to the peculiar joint deformity and the small size of the bones. We present a case of a bilateral hip replacement in a dwarf patient. In order to reduce intraoperative complications and improve the joint kinematics a thorough preoperative planning was performed by a CT based computerised system. On the basis of the planning we chose a conical shaped stem that enable as to restore limb length and offset with a low risk of femoral fracture. In conclusion, we consider total hip replacement in dwarfism a safe and effective procedure if an accurate preoperative planning is performed.     

Hip dislocation revealing hip tuberculosis. A case report

Hip dislocation is an uncommon presentation of hip tuberculosis. We report a case in an 18-year-old woman with active hip tuberculosis. An attempt to reduce the dislocation 7 weeks into antituberculous therapy was followed by necrosis of the femoral head. Although severe forms of hip tuberculosis are common in endemic areas, dislocation is exceedingly rare. Capsule laxity and/or synovial hypertrophy probably contribute more to the occurrence of dislocation than does the accumulation of pus.     

Total scalp avulsion with microvascular reanastomosis: A case report and literature review

Total scalp avulsion is a rare but potentially devastating injury that when treated (following a few basic principles) can have very good reconstructive results. The present article reviews the current literature and describes the steps involved in the successful replantation of a complete avulsed scalp of a 33-year-old woman. To the authors’ knowledge, the present case regarding replantation of a complete avulsed scalp using only a single artery is the first to be described in the Canadian literature.     

Total hip replacement in a patient with systemic mastocytosis: a case report

Systemic mastocytosis is a rare condition that often involves the bone marrow. We report the case of a patient with systemic mastocytosis who underwent total hip replacement. Technical difficulties encountered during the procedure included a narrow medullary canal and abnormally hard bone, later confirmed by laboratory measurements. Follow-up at five years showed a good clinical and radiological outcome.     

Mycobacterium marinum epididymoorchitis: case report and literature review

Mycobacterium marinum is the most frequent non-tuberculous Mycobacterium in humans. We report the first ever described case of epididymoorchitis resulting from hematogenous spread of M. marinum from hand oligoarthritis. This was initially mistaken for rheumatoid disease and methylprednisolone-induced immunosuppression led to hematogenous spread of infection to the testis and epididymis.     

Yersinia enterocolitica coxitis after hip replacement. A case report

We report a case of hematogenous Yersinia enterocolitica coxitis 10 years after hip replacement. Despite extraction of the prosthesis and antibiotic treatment, the infection relapsed. Infections in replaced joints with Yersinia enterocolitica call for long-standing treatment with specific antibiotics.