Total hip arthroplasty in patients with active tuberculosis of the hip with advanced arthritis.

UNLABELLED: Osteoarticular tuberculosis (TB) in the hip and other joints is increasing and patients in developing countries commonly present with advanced joint destruction. We asked whether TB is reactivated after THA in these patients. We retrospectively reviewed 12 patients with an average age of 45 years who had advanced stages of hip destruction secondary to mycobacterium TB and who were treated with primary THA and prescribed perioperative antituberculous medication for 12 to 18 months postoperatively. Diagnosis in all these patients was confirmed by histopathology and culture. The minimum followup was 25 months (average, 41 months; range, 25-58 months). We observed no reactivation of TB in 11 patients who had Harris hip scores ranging from 86 to 97. One patient who postoperatively did not comply with the antituberculous chemotherapy had reactivation and superimposed infection through a nonhealing sinus tract; that patient underwent component removal and resection arthroplasty. When the infected tissue can be débrided and adequate antituberculous therapy is instituted the outcome of joint arthroplasty may not be adversely affected. THA in the tuberculous hip has a low risk of reactivation and produces good functional results. LEVEL OF EVIDENCE: Level IV, therapeutic case series (no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

High prevalence of vitamin D deficiency in Asian-Indian patients with fragility hip fracture: a pilot study.

OBJECTIVE: To assess vitamin D nutrition status in Asian-Indian patients with fragility hip fracture. METHODS: The study subjects included patients with non-traumatic hip fracture with age more than 50 years. Any patient who sustained fracture after road side accident of any severity was excluded. The other exclusion criteria were history of previous non-traumatic fracture or history of intake of systemic steroids, anti-osteoporotic medication, anti-tubercular or antiepileptic drugs. Routine biochemistry, serum 25-hydroxy vitamin D [25(OH)D] and BMD (DXA) were measured in all patients. Diagnosis of vitamin D deficiency (VDD) was considered when serum 25(OH)D levels were < 20 ng/ml. Age and sex matched apparently healthy subjects (without history of fracture at any site) were selected from general population. All controls under went BMD measurement at spine. RESULT: Final analysis included 43 patients, 9 men (20.9%) and 34 women (79.0%, all postmenopausal). The mean age of patients was 62.2 +/- 12.3 years (range 50.5 to 74.2 years, men--62 +/- 13.4 years; women--62.3 +/- 12.4 years; p 0.73). History of adequate sun exposure was obtained in 34.8% cases only. Fracture occurred while patients were outside home in 10/43 (23.25%) while 33/43 (76.7%) patients sustained fracture at home. Of all fractures occurring at home, 51.5% patients sustained fracture consequent to fall/slip in the bathroom. The mean serum 25(OH)D level was 9.9 +/- 4.8 ng/ml (range 5-21.5 ng/ml). All patients except one (96.7%) had VDD. No significant difference in serum 25(OH)D levels was observed between patients with and without adequate sun exposure. BMD of patients with fragility fractures were significantly low in comparison to BMD of healthy controls. (cases --0.790 +/- 0.1 gm/sq cm vs controls 0.924 +/- 0.1 gm/sq cm; p 0.000). The mean Z-score of spine BMD of cases was -1.13 +/- 1.4. No significant difference was observed in the BMD of patients with or without adequate sun exposure and with or without calcium and vitamin D supplementation at the time of fracture. Similarly, no significant difference was noted in BMD of patients with severe VDD and patients with mild to moderate VDD. All patients were contacted by telephone one year after the surgery (mean 12.3 months, range 9 to 13 months). Out of total 43 patients, 26 patients/families could be contacted, 11 (42.3%) died within one year of surgery, of which 8 patients died within first 6 months after surgery. Two patients died within 72 hours after discharge from hospital. Of 15 patients alive one year after surgery, two were able to walk without any support while 13 were able to walk with some support (stick or walker). CONCLUSION: Our study shows very high prevalence (96.7%) of vitamin D deficiency in Asian-Indian patients with fragility hip fracture. The BMD of these patients is significantly low in comparison to age and sex matched healthy controls. More fractures occurred at home than outside, with a majority of fall being in the bathroom.