Tuberculosis of hip

Abstract

Tuberculosis (TB) of the hip is second to spine only hence a good number of cases are visiting the medical facilities every year. Many present in the advanced stage of the disease due to delayed diagnosis. In early stages of TB of hip, there is a diagnostic dilemma when plain X-rays are negative. In the present time, diagnostic modalities have improved from the days when diagnosis was based essentially on clinicoradiological presentation alone. By the time definite radiological changes appear on plain X-ray, the disease has moderately advanced. The modern diagnostic facilities like ultrasonography (USG) or magnetic resonance imaging of the hip joint, USG guided aspiration of synovial fluid and obtaining the material for polymerase chain reaction and tissue diagnosis must be utilized. In the treatment, current emphasis is more on mobility with stability at hip. Joint debridement, skeletal traction, and mobilization exercises may give more satisfying results as compared to the immobilization by hip spica. Adults with advanced arthritis and healed infection should be informed and discussed the various treatment modalities including the joint replacement. More and more surgeons are taking up the challenge of putting the total hip replacement in the active stage of the disease. Until the long term results in active disease are well established, we recommend it for the healed disease only in selected cases.

Cemented Total Hip Arthroplasty for Neglected Tuberculosis of the Hip in Endemic Area (Papua, Indonesia): A Case Report

“…In TB endemic areas such as Papua, a therapeutic trial using the principle of treating instead of testing first is preferred when the typical clinical and radiographic features of TB are present [2]. In cases of extensive TB disease of the hip many surgical techniques are available such as arthrotomy with debridement, arthrodesis, girdlestone or total hip arthroplasty (THA).…”

“…Improvement of ROM as well as the reduction of pain post operatively can be obtained by regular preoperative physiotherapy [3,4]. Employment of effective anti-tubercular drugs can reduces the chances of recrudescence significantly [2].…”

“…In endemic areas, treatment of tuberculosis in the hip should be done immediately [2]. In this case we can see the progression of the neglected tuberculosis of the hip which is not immediately performed surgery treatment that should be done due to lack of resources, how treatment should be and some kind of treatment that is applied to this patient included the application of cemented THA.…”

“…Most tuberculosis affects are spinal, hip or knee. TB of the hip constitutes 15%-20% of the musculoskeletal system [1,2].…”

Primary Extrapulmonary Extensively Drug Resistant Tuberculosis of the Hip in an Immunocompetent Female-A Case Report

“…Also, the patient was well nourished, belonged to a well to do family and thus a high index of suspicion was required to diagnose such a case. Saraf SK et al, 2015, reported that the diagnosis is often delayed in the TB hip cases [8]. The endemicity of TB in India could well be a major contributor to such primary extrapulmonary XDR-TB case.…”