Hip tuberculosis managed with spacer and delayed THR: A case report

Abstract

Osteoarticular tuberculosis is an uncommon but disabling manifestation of extrapulmonary tuberculosis, with the hip being the second most frequently affected joint after the spine. Advanced disease often results in severe pain, deformity, and joint destruction, necessitating surgical intervention. While total hip replacement (THR) provides the best functional outcome, concerns remain regarding timing, persistence of infection, implant survival, and complications. Staged replacement with interim antibiotic-loaded cement spacers is well established in pyogenic infections, but its role in tubercular hips is less common, and spacer-related complications are rarely reported. We report the case of a 50-year-old female with advanced tubercular arthritis of the hip who presented with severe pain and inability to walk for six months. Imaging revealed destructive changes and a pestle-and-mortar deformity. Following extensive debridement, a cement spacer was inserted, though intraoperative difficulty due to a narrow femoral canal required modification of the spacer. She was started on standard antitubercular therapy and mobilised with support. Seven months later, she developed pain and difficulty in ambulation, and radiographs demonstrated fracture through the neck of the cement spacer. With no signs of active infection, she underwent cemented total hip replacement using a multi-hole cup. Postoperatively, she recovered uneventfully, continued antitubercular therapy, and achieved significant functional improvement, with a Harris Hip Score of 85 at nine months. This case underscores the importance of individualized surgical planning in advanced hip tuberculosis, especially in the presence of narrow femoral canals. Spacer fracture, though rare, should be anticipated as a potential complication. Cemented components and extended antitubercular therapy can provide stable fixation and excellent outcomes. Staged arthroplasty remains a reliable option for restoring mobility and quality of life in such patients.