Hip Surgery in Quiescent or Active Tubercular Hip Arthritis; Is Reactivation Risk Really a Matter



1 Massachusetts General Hospital, Harvard medical School, Boston, MA, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Community and Preventive Medicine Specialist, Mashhad University of Medical Sciences, Mashhad, Iran

3 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Pediatrics, Mashhad University of Medical Sciences, Mashhs, Iran


About 15 % of all musculoskeletal tuberculosis (TB) have hip involvement. Early anti-tubercular drug therapy and other conservative treatment including short-term traction and mobilization programs could prevent hip joint destruction. Reactivation of TB accounts for a significant of active TB incidence, especially in the developed countries with a low TB prevalence. The risk of TB activation for population with the latent form of disease is about 5-10%. According to the existing literature surgery in tubercular hip arthritis would be safe once sufficient debridement and precise anti tubercular chemotherapy has been done.


Main Subjects

1. Babhulkar S, Pande S. Tuberculosis of the hip. Clin Orthop Relat Res. 2002; 398(1):93-9.
2. Birjandinejad A, Parsa A, Ebrahimzadeh MH.
Isolated tuberculosis of the talonavicular joint in a
child. Foot. 2012; 22(3):255-7.
3. Jeddo S, Huang CW, Li M. Case report on the recurrence
of tuberculosis of hip after 40 years. Springerplus.
2014; 3(1):662.
4. Held MF, Hoppe S, Laubscher M, Mears S, Dix-Peek
S, Zar HJ, et al. Epidemiology of musculoskeletal
tuberculosis in an area with high disease prevalence.
Asian Spine J. 2017; 11(3):405-11.
5. World Health Organization. World malaria report
2015. Geneva: World Health Organization; 2016.
6. Johansen IS, Nielsen SL, Hove M, Kehrer M, Shakar S,
Wøyen AV, et al. Characteristics and clinical outcome
of bone and joint tuberculosis from 1994 to 2011: a
retrospective register-based study in Denmark. Clin
Infect Dis. 2015; 61(4):554-62.
7. Peto HM, Pratt RH, Harrington TA, LoBue PA,
Armstrong LR. Epidemiology of extrapulmonary
uberculosis in the United States, 1993-2006. Clin
Infect Dis. 2009; 49(9):1250-7.
8. Malaviya AN, Kotwal PP. Arthritis associated with
tuberculosis. Best Pract Res Clin Rheumatol. 2003;
9. Gharehdaghi M, Hassani M, Ghodsi E, Khooei A,
Moayedpour A. Bacille Calmette-Guérin Osteomyelitis.
Arch Bone Jt Surg. 2015; 3(4):291-5.
10. Elmi A, Tabrizi A, Tolouei FM. Skeletal tuberculosis
presenting as a small cystic lesion in the medial
femoral condyle. Arch Bone Jt Surg. 2013; 1(2):112-5.
11. Yadav S, Rawal G. Primary extrapulmonary
extensively drug resistant tuberculosis of the hip in an
immunocompetent female-a case report. J Clin Diagn
Res. 2017; 11(1):LD01-3.
12. Agarwal SP, Chauhan LS. Tuberculosis control in India.
New Delhi: Directorate General of Health Services,
Ministry of Health and Family Welfare; 2005.
13. Lešić AR, Pešut DP, Marković-Denić L, Maksimović J,
Č􀆽obeljić G, Milosevic I, et al. The challenge of osteoarticular
tuberculosis in the twenty-first century: a
15-year population-based study. Int J Tuberc Lung
Dis. 2010; 14(9):1181-6.
14. Mazloumi SM, Ebrahimzadeh MH, Kachooei AR.
Evolution in diagnosis and treatment of Legg-
Calve-Perthes disease. Arch Bone Jt Surg. 2014;
15. De Backer AI, Vanhoenacker FM, Sanghvi DA.
Imaging features of extraaxial musculoskeletal
tuberculosis. Indian J Radiol Imaging. 2009;
16. Robben SG. Ultrasonography of musculoskeletal
infections in children. Eur Radiol. 2004; 14(4):L65-
17. Ai JW, Ruan QL, Liu QH, Zhang WH. Updates on the
risk factors for latent tuberculosis reactivation and
their managements. Emerg Microbes Infect. 2016;
18. Kumar V, Garg B, Malhotra R. Total hip replacement
for arthritis following tuberculosis of hip. World J
Orthop. 2015; 6(8):636-40.
19. Restrepo BI, Fisher-Hoch SP, Pino PA, Salinas A, Rahbar
MH, Mora F, et al. Tuberculosis in poorly controlled
type 2 diabetes: altered cytokine expression in
peripheral white blood cells. Clin Infect Dis. 2008;
20. Dooley KE, Chaisson RE. Tuberculosis and diabetes
mellitus: convergence of two epidemics. Lancet Infect
Dis. 2009; 9(12):737-46.
21. Smieja MJ, Marchetti CA, Cook DJ, Smaill FM.
Isoniazid for preventing tuberculosis in non‐HIV
infected persons. Cochrane Database Syst Rev. 2000;
22. Stagg HR, Zenner D, Harris RJ, Muñoz L, Lipman
MC, Abubakar I. Treatment of latent tuberculosis
infection: a network meta-analysis. Ann Internal Med.
2014; 161(6):419-28.
23. Rangaka MX, Wilkinson KA, Glynn JR, Ling D, Menzies
D, Mwansa-Kambafwile J, et al. Predictive value
of interferon-γ release assays for incident active
tuberculosis: a systematic review and meta-analysis.
Lancet Infect Dis. 2012; 12(1):45-55.
24. Diel R, Goletti D, Ferrara G, Bothamley G, Cirillo D,
Kampmann B, et al. Interferon-γ release assays for
the diagnosis of latent Mycobacterium tuberculosis
infection: a systematic review and meta-analysis. Eur
Respir J. 2011; 37(1):88-99.
25. Ha KY, Chung YG, Ryoo SJ. Adherence and biofilm
formation of Staphylococcus epidermidis and
Mycobacterium tuberculosis on various spinal
implants. Spine (Phila Pa 1976). 2005; 30(1):38-43.
26. Neogi DS, Yadav CS, Ashok Kumar SA, Rastogi S. Total
hip arthroplasty in patients with active tuberculosis
of the hip with advanced arthritis. Clin Orthop Relat
Res. 2010; 468(2):605-12.
27. Yoon TR, Rowe SM, Santosa SB, Jung ST, Seon JK.
Immediate cementless total hip arthroplasty for the
treatment of active tuberculosis. J Arthroplasty. 2005;
28. Santavirta S, Eskola A, Konttinen YT, Tallroth
K, Lindholm ST. Total hip replacement in old
tuberculosis: a report of 14 cases. Acta Orthop Scand.
1988; 59(4):391-5.
29. Tan SM, Chin PL. Total hip arthroplasty for surgical
management of advanced tuberculous hip arthritis:
case report. World J Orthop. 2015; 6(2):316-21.
30. Ö􀇆 ztürkmen Y, Karamehmetoğlu M, Leblebici C, Gökçe
A, Caniklioğlu M. Cementless total hip arthroplasty
for the management of tuberculosis coxitis. Arch
Orthop Trauma Surg. 2010; 130(2):197-203.
31. Johnson R, Barnes KL, Owen R. Reactivation of
tuberculosis after total hip replacement. J Bone Joint
Surg Br. 1979; 61(2):148-50.
32. Kim YH, Han DY, Park BM. Total hip arthroplasty for
tuberculous coxarthrosis. J Bone Joint Surg Am. 1987;
33. Li L, Chou K, Deng J, Shen F, He Z, Gao S, et al. Twostage
total hip arthroplasty for patients with advanced
active tuberculosis of the hip. J Orthop Surg Res. 2016;
34. Oga M, Arizono T, Takasita M, Sugioka Y. Evaluation of
the risk of instrumentation as a foreign body in spinal
tuberculosis: clinical and biologic study. Spine. 1993;18(13):1890-4.
35. Tiwari V, Khan SA, Kumar A, Poudel R, Kumar VS.
Functional improvement after hip arthroscopy in
cases of active paediatric hip joint tuberculosis:
a retrospective comparative study vis-à-vis
conservative management. J Child Orthop. 2015;
36. Hardinge K, Cleary J, Charnley J. Low-friction
arthroplasty for healed septic and tuberculous
arthritis. J Bone Joint Surg Br. 1979; 61-B(2):144-7.
37. Jupiter JB, Karchmer AW, Lowell JD, Harris WH. Total
hip arthroplasty in the treatment of adult hips with
current or quiescent sepsis. J Bone Joint Surg Am.
1981; 63(2):194-200.