https://doi.org/10.4081/ejtm.2026.15594
From destruction to restoration: total hip arthroplasty in advanced hip joint tuberculosis. A case report
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Published: 19 August 2026
Hip Tuberculosis (HTB) is a severe form of extrapulmonary Tuberculosis (TB) that can lead to progressive joint destruction, functional impairment, and reduced Quality Of Life (QoL). Optimal management requires timely Antitubercular Therapy (ATT), appropriate surgical intervention, and structured rehabilitation. This case report aims to present a 57-year-old Bulgarian female with advanced HTB, persisting chronic pain, severe functional limitation, and marked restriction in Range Of Motion (ROM) and Muscle Strength (MS). Baseline assessment revealed a Harris Hip Score (HHS) of 56 and pain intensity of 7/10 on the Visual Analogue Scale (VAS). Microbiological confirmation of Mycobacterium tuberculosis was obtained via bone biopsy. Following completion of ATT and normalization of inflammatory markers, the patient underwent Total Hip Arthroplasty (THA) using an anterolateral approach. An individualized Exercise-Based Postoperative Rehabilitation Program (EBRP) was implemented. At 6-Hip Flexion (HF) improved from 25° to 55°, while hip abduction increased from 15° to 40°.MS improved from 2/5 to 4+/5 in key muscle groups (MG). Functional performance improved significantly, with HHS increasing from 56 to 81 (+44.6%), and pain decreasing from 7/10 to 2/10 (−71.4%). No postoperative complications or infection recurrence were observed. This case highlights the importance of appropriate timing of THA after successful infection control with ATT, combined with a structured EBRP. A multidisciplinary approach is essential to optimize functional recovery and minimize complications in patients with HTB.
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1. Bansal A, Sharma S, Dhillon MS. Bone and Joint Tuberculosis. In Textbook of Orthopedic Infections: A Comprehensive Guide to Diagnosis and Management 2026 Feb 1 (pp. 235-255). Singapore: Springer Nature Singapore. DOI: https://doi.org/10.1007/978-981-95-5029-6_17
2. Zheng S, Li M, Chen H, Qin Y. Total hip arthroplasty in hip tuberculosis: a systematic review. BMC Musculoskelet Disord 2025;26:46. DOI: https://doi.org/10.1186/s12891-024-08053-1
3. Li L, Chou K, Deng J, et al. Two-stage total hip arthroplasty for patients with advanced active tuberculosis of the hip. J Orthop Surg Res 2016;11:38. DOI: https://doi.org/10.1186/s13018-016-0364-3
4. Singh R, Landge S, Goyal S, Goel S, Upadhyay AR. Management of Tuberculosis of the Hip With Antitubercular Therapy and Single-Stage Total Hip Replacement: A Case Report. Cureus 2024;16:e65110. DOI: https://doi.org/10.7759/cureus.65110
5. Zhang J, Liang L, Yang B, Li S, et al. Total hip arthroplasty for tuberculosis: a case series. Ann Palliat Med 2021;10:495-500. DOI: https://doi.org/10.21037/apm-20-2544
6. Viswanathan VK, Patralekh MK, Kalanjiyam GP, et al. Total hip arthroplasty in active and advanced tubercular arthritis: a systematic review of the current evidence. Int Orthop 2024;48:79-93. DOI: https://doi.org/10.1007/s00264-023-05943-2
7. Kaur G, Gangwani N, Sharath HV. A case report on advanced hip tuberculosis: outcomes of combined surgical and rehabilitative intervention. Cureus 2024;16:e68309. DOI: https://doi.org/10.7759/cureus.68309
8. Akkerman OW, Ter Beek L, Centis R, et al. Rehabilitation, optimized nutritional care, and boosting host internal milieu to improve long-term treatment outcomes in tuberculosis patients. Int J Infect Dis 2020;92S:S10-S14. DOI: https://doi.org/10.1016/j.ijid.2020.01.029
9. Bulzan M, Cavalu S, Voiță-Mekereș F, Hozan CT. Assessment of pain intensity after total hip arthroplasty using the Visual Analogue Scale (VAS). J Med Life 2024;17:1049-53. DOI: https://doi.org/10.25122/jml-2024-0362
10. Singh JA, Schleck C, Harmsen S, Lewallen D. Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord 2016;17:256. DOI: https://doi.org/10.1186/s12891-016-1106-8
CRediT authorship contribution
Nedelcho Tzachev, Virna Maria Tsitou, conceptualization; Nedelcho Tzachev, Virna Maria Tsitou, and Jannis Papathanasiou, methodology; Radoslav Milev, Nikola Hariskov, and Nedelcho Tzachev, formal analysis; Virna Maria Tsitou and Jannis Papathanasiou, data curation; Plamen Ivanov and Petko Ginev, writing—original draft preparation; Radoslav Milev and Plamen Ivanov, writing—review and editing; Nedelcho Tzachev, Jannis Papathanasiou and Virna Maria Tsitou, supervision. All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the manuscript.
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