From destruction to restoration: total hip arthroplasty in advanced hip joint tuberculosis. A case report

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Abstract
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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