Total hip arthroplasty in different types of advanced tubercular hip arthritis: is it justified.

PURPOSE: Total hip arthroplasty (THA) provides a good treatment option for the patients in late arthritis stage. We present our experience of THA in various spectrums of disease. METHODS: Retrospective study including 23 advanced tubercular hip arthritis patients over a period of 13 years. The patients with active discharging sinus were excluded from the study. The patients were divided into three groups: group 1 (healed TB), group 2 (active TB), and group 3 (intraoperative surprise). The preoperative and postoperative antitubercular treatment (ATT) was administered to all the patients as per the protocol for various duration. All patients underwent THA (cementless or hybrid) after investigations including MRI. The patients were followed up with clinic-radiological and laboratory investigations. RESULTS: The mean age of the patients was 58.2 years with 16 males and seven females. There were 14 healed TB hips, eight active TB hips, and one intraoperative TB hip patient. Preoperative ATT duration in group 1 varied from one to two weeks and in group 2 patient's average was 9.6 weeks (range: 6-12weeks). Postoperatively, ATT was given for a minimum of ten months extending to 16 months. Cementless THA was performed in 17 patients and hybrid THA (cemented stem) in six patients. Only one patient had aseptic loosening of the stem and revision arthroplasty was done. CONCLUSION: THA is a viable option and provides mobile, stable hip in tubercular hip arthritis even in active TB hip patients. ATT is important in the management and prevent the reactivation of the disease.

Stress Fracture of the Femoral Neck Following Total Knee Arthroplasty: A Case Series.

A stress fracture of the femoral neck after total knee arthroplasty (TKA) is rare, with few reported cases in the English literature. We defined a stress fracture following TKA as a nontraumatic fracture developing in the femoral neck within six months of TKA. This retrospective case series highlights the predisposing factors, diagnostic challenges, and management of stress femoral neck fractures following TKA. In our series, the major risk factors for the fracture are an increase in the level of activity in osteoporotic bone after a period of relative immobility after TKA, steroid intake, and rheumatoid arthritis. Preoperative dual-energy X-ray absorptiometry (DEXA) screening may help in the early initiation of osteoporosis treatment as the majority of our cases come late in the knee arthritis stage and long after a period of relative inactivity. Timely diagnosis and management of a stress femur neck fracture in the early period may prevent fracture displacement, avascular necrosis, and nonunion.