Management of tuberculous hip ankylosis using dual-approach total hip arthroplasty and gluteal reconstruction: A case report

Tuberculous hip ankylosis is an uncommon but disabling sequela of osteoarticular tuberculosis. We report a 34-year-old man with long-standing post-tuberculous complete osseous ankylosis of the right hip, severe deformity, and abductor deficiency. Magnetic resonance imaging showed complete fusion and advanced fatty degeneration of the gluteus medius and minimus without features of active infection. He underwent dual- approach total hip arthroplasty using a dual-mobility acetabular construct, cementless conical stem fixation, and abductor reconstruction with gluteus maximus and tensor fascia lata transfer. At 7 months, hip flexion reached 90°, hip pain improved from 7/10 to 2/10, and mechanical low-back pain improved from 8/10 to 3/10. The patient walked without an aid, with improved gait mechanics but residual abductor weakness. Radiographs showed stable implant positioning without loosening, subsidence, heterotopic ossification, or periprosthetic lucency. This case demonstrates early clinical and radiographic improvement in a carefully selected complex post-tuberculous reconstruction.