Abstract:
This case study presents the intricate management of a challenging TUBERCULAR HIP case at Gadge Hospital, under the expertise of Dr. Swapnil Gadge. The patient, initially planned for hip replacement, was found to have a hip joint filled with pus during the surgical procedure. The acetabular region showed signs of infection, necessitating culture and bone histopathology assessments. Due to the Accidental Finding of pus in hip joint, the procedure was deferred.
Two Stage Surgery was planned, pus collected was sent for culture and sensitivity and the soft tissue was sent for histopathology to find out the causative organism. Thorough debridement of wound done, copious wash given. To address the severe infection, handmade cement spaces infused with antibiotics were meticulously crafted, offering a delivery of high concentration of antibiotics locally to control the spread of infection. Further investigations revealed the presence of a M.Tuberculosis with positive TB culture. The patient was promptly started on Antitubercular therapy (AKT) for a duration of one year to eradicate the tubercular infection.
After four to five months of intensive medical management, blood investigations indicated a controlled infection, paving the way for the much-needed hip replacement surgery. The surgical team, led by Dr. Swapnil Gadge, successfully performed the hip replacement procedure, overcoming the challenges posed by the prior infection.
Key Highlights:
- Diagnostic Challenges: The unexpected discovery of an infected acetabulum posed diagnostic challenges, leading to a revised treatment plan.
- Innovative Surgical Approach: Two Stage Surgery Antibiotic Impregnated Handmade Cement Spacer inserted to control the infection and maintain joint space integrity, enabling a safer environment for future surgery.
- Multidisciplinary Management: A coordinated effort between orthopedic surgeon Dr. Swapnil Gadge & his team was crucial for effective diagnosis and treatment.
- Tubercular Cold Abscess: The case emphasised the importance of considering tuberculosis in atypical orthopaedic infections, necessitating a tailored approach to treatment.
- Successful Outcome: Despite the complexities, the patient achieved a successful hip replacement and early postoperative ambulation, demonstrating the efficacy of the comprehensive management strategy.
The postoperative period was characterised by a remarkable recovery, with the patient demonstrating the ability to walk on the second-day post-surgery. This case highlights the comprehensive approach employed at Gadge Hospital in managing complex orthopedic cases, showcasing the skills and expertise of Dr. Swapnil Gadge and his team. The success of this case demonstrates the hospital’s commitment to delivering quality healthcare and overcoming challenging scenarios in orthopedic surgery.