Pediatric Tuberculous Osteomyelitis of the Hip Managed with an Antibiotic-Loaded Cement Spacer Fabricated Using a 3D-Printed Mold: A Case Report

Abstract

Purpose: To describe a pediatric case of advanced tuberculous osteomyelitis of the hip managed with an antibiotic-loaded cement spacer fabricated using a three-dimensional (3D)-printed mold.

Methods: An 11-year-old child patient with a 2-year history of progressive hip pain, draining sinus formation, and inability to bear weight underwent staged surgical management, including debridement, sequestrectomy, and Girdlestone procedure. Radiographs demonstrated extensive proximal femoral osteolysis with superolateral displacement of the femoral head. Initial microbiologic studies were negative for Mycobacterium tuberculosis, while blood cultures grew Burkholderia cepacia. Histopathology later demonstrated caseating granulomatous inflammation consistent with tuberculosis. A patient-specific antibiotic-loaded cement spacer was fabricated using a 3D-printed mold based on contralateral hip measurements and implanted during the second-stage procedure.

Results: The patient initially showed clinical improvement, with reduced pain and decreased inflammatory markers. At 2 months, spacer displacement was noted, which was associated with poor functional outcomes (Harris Hip Score, 15.19). Long-term follow-up of the patient was not completed.

Conclusions: Customized spacer fabrication using 3D printing is feasible for pediatric patients with hip infections. However, outcomes may be limited in patients with advanced disease. Careful patient selection and follow-up are essential.