BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condit...BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.展开更多
Background: This study aimed to propose a classification of acetabular defects in advanced-stage hip tuberculosis based on preoperative radiographs and intraoperative evaluation, thereby providing options for reconstr...Background: This study aimed to propose a classification of acetabular defects in advanced-stage hip tuberculosis based on preoperative radiographs and intraoperative evaluation, thereby providing options for reconstructing each type of defect in hip arthroplasty. Materials and Methods: We conducted a prospective study with 45 patients with active hip tuberculosis at stage IV who were treated with a total hip replacement strategy. We collected the patients’ acetabular defect data from preoperative radiographs and intraoperative observations. The defects were classified into types based on defect severity and reconstructive complexity. The hip replacement outcomes were evaluated at least 12 months after the operation. Results: The classification system includes three types: type I: localized or extensive defects inside the acetabulum, not affecting the acetabular rim, medial wall, or columns. Type II: extensive defects inside the acetabulum, affecting the acetabular rim or (and) medial wall. Type III: extensive defects inside the acetabulum, causing the medial wall and the acetabular column to lose function. Each type has a corresponding reconstruction. The outcome includes that 41/45 patients had excellent results;3/45 patients had good results. The patients had good results due to nerve and muscle damage caused by tuberculosis not related to the acetabular defects. Conclusion: This is a simple, practical classification system of acetabular defects in hip tuberculosis. The outcome of hip reconstruction using this classification was excellent without any cases of dislocation or protrusion.展开更多
Background: Treatment of hip disorders during active hip tuberculosis has long been a controversial issue. Some authors have reported performing hip replacement with different strategies with very good outcomes. This ...Background: Treatment of hip disorders during active hip tuberculosis has long been a controversial issue. Some authors have reported performing hip replacement with different strategies with very good outcomes. This study aimed to describe the surgical outcomes and necessary conditions for total hip replacement in active hip tuberculosis. Methods: We conducted a quasi-experimental study. The study enrolled 40 patients with 42 active tuberculosis hips at stage IV treated by total hip replacement from October 2016 to December 2019 at the National Lung Hospital. We followed up with the patients for at least 12 months, evaluated surgical outcomes, and investigated the factors associated with these outcomes by logistic regression analysis. Results: Surgical outcomes showed that 37 patients (88.1%) had excellent hip function, no abscesses, and no sinus tract formation. Four cases (9.5%) had sinus tract formations. One case (2.4%) had good hip function. Binary logistic regression models revealed that sinus tract formation was associated with preoperative tuberculosis infection syndrome. The average time to obtain antituberculosis drug treatment preoperatively was 4.6 weeks. Conclusion: Total hip replacement for active hip tuberculosis is a practical and promising treatment method. Surgeons should consider improving patients’ conditions before performing total hip replacement, administering antitubercular drugs, and arthrotomy to eliminate all abscesses, and decrease the risk of tuberculosis infection syndrome and the inflammatory response.展开更多
基金Basic Public Welfare Research Project of Zhejiang Province,No.GF20H200021Luqiao Science and Technology Bureau Foundation,No.2019A23005.
文摘BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.
文摘Background: This study aimed to propose a classification of acetabular defects in advanced-stage hip tuberculosis based on preoperative radiographs and intraoperative evaluation, thereby providing options for reconstructing each type of defect in hip arthroplasty. Materials and Methods: We conducted a prospective study with 45 patients with active hip tuberculosis at stage IV who were treated with a total hip replacement strategy. We collected the patients’ acetabular defect data from preoperative radiographs and intraoperative observations. The defects were classified into types based on defect severity and reconstructive complexity. The hip replacement outcomes were evaluated at least 12 months after the operation. Results: The classification system includes three types: type I: localized or extensive defects inside the acetabulum, not affecting the acetabular rim, medial wall, or columns. Type II: extensive defects inside the acetabulum, affecting the acetabular rim or (and) medial wall. Type III: extensive defects inside the acetabulum, causing the medial wall and the acetabular column to lose function. Each type has a corresponding reconstruction. The outcome includes that 41/45 patients had excellent results;3/45 patients had good results. The patients had good results due to nerve and muscle damage caused by tuberculosis not related to the acetabular defects. Conclusion: This is a simple, practical classification system of acetabular defects in hip tuberculosis. The outcome of hip reconstruction using this classification was excellent without any cases of dislocation or protrusion.
文摘Background: Treatment of hip disorders during active hip tuberculosis has long been a controversial issue. Some authors have reported performing hip replacement with different strategies with very good outcomes. This study aimed to describe the surgical outcomes and necessary conditions for total hip replacement in active hip tuberculosis. Methods: We conducted a quasi-experimental study. The study enrolled 40 patients with 42 active tuberculosis hips at stage IV treated by total hip replacement from October 2016 to December 2019 at the National Lung Hospital. We followed up with the patients for at least 12 months, evaluated surgical outcomes, and investigated the factors associated with these outcomes by logistic regression analysis. Results: Surgical outcomes showed that 37 patients (88.1%) had excellent hip function, no abscesses, and no sinus tract formation. Four cases (9.5%) had sinus tract formations. One case (2.4%) had good hip function. Binary logistic regression models revealed that sinus tract formation was associated with preoperative tuberculosis infection syndrome. The average time to obtain antituberculosis drug treatment preoperatively was 4.6 weeks. Conclusion: Total hip replacement for active hip tuberculosis is a practical and promising treatment method. Surgeons should consider improving patients’ conditions before performing total hip replacement, administering antitubercular drugs, and arthrotomy to eliminate all abscesses, and decrease the risk of tuberculosis infection syndrome and the inflammatory response.
