To investigate the efficacy of minimally invasive surgical treatment on brucellosis hip arthritis complicated with early femoral head necrosis.

Data of 18 patients with brucellosis hip arthritis and early femoral head necrosis from the Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University from November 2012 to March 2016 was collected. Local symptoms remained poor for the 18 cases after 2-3 courses of preoperative treatment with a four-linked anti-brucellosis agent (doxycycline + rifampicin + levefloxacin + sodium ceftreaxone), then all patients were treated with core decompression combined with allograft bone grafting and joint cavity puncture irrigation. Postoperatively, the clinical efficacy were assessed by pain visual analogue score (VAS), hip function Harris score, erythrocyte sedimentation rate (ESR) and C-response protein (CRP).

All 18 patients achieved post-surgical incision Ⅰ phase. Postoperative pathological observation showed that the 18 patients had bone structural necrosis and synovial hyperplasia, Moreover, B. glomeruli was found by Gimesa staining. Among the typical cases, the preoperative hip X line showed the normal appearance of the right femoral head and the presence of joint gaps, the scattered capsule shadow could be seen in the femoral head. CT showed that the right femoral head was visibly scattered in the capsule shadow, with edge hardening. MRI showed abnormal signal changes in the right hip bone and surrounding soft tissue, T1WI showed a low signal, T2-weighted imaging (T2WI) and T2-weighted imaging (T2WI) with pressure fat showed promiscuous high signals, and strengthening signals could be seen after enhancement. The hip X line was reviewed 12 months after surgery, which showed bone filling in the cystic region; CT showed bone packing in cystic necrotic region; MRI showed abnormal signal changes in bone and soft tissue. All 18 patients had significant improvements in hip pain and hip function. VAS scores (F = 260.721, P < 0.001) and Harris scores (F = 157.585, P < 0.001) of 18 cases at preoperative, 1, 3, 6, 12 and 24 months after surgery were significantly different. The levels of ESR (F = 19.715, P < 0.001) and CRP (F = 34.882, P < 0.001) of 18 cases were significantly different at the above time points.

Based on drug treatment, patients of brucellosis hip arthritis complicated with early femoral head necrosis could relieve or remove the pain through minimally invasive surgical treatment, which could benefit to the early recovery.