In particular, trochanteric bursitis is an extremely rare manifestation of osteoarticular tuberculosis. We describe a case of tuberculous coxitis. Tuberculosis of the hip joint region in children. MAF MohideenI; MN RasoolII. I MBChB(Medunsa). Registrar. Nelson Mandela School of Medicine, University of . PubMed journal article [Tuberculous coxitis in the hips 55 years after primary tuberculosis were found in PRIME PubMed. Download Prime PubMed App to.
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A natural course of a dislocated healed tuberculous hip in a child. Extra-articular osseous involvement was seen in the proximal femur, greater and lesser trochanter, ilium, ischium and body of the pubis Table II. Its acceptance in Indian subcontinent is very low due to socio cultural reasons. Current concepts in bone and joint tuberculosis. Fibrous ankylosis was seen in two cases in this study. The patient underwent reconstructive surgery by extirpation of the granuloma from the acetabulum and augmentation with autologous spongiosaplasty from the ipsilateral iliac crest.
After seven months the microbiological examination of gastric secretion and sputum analysis did not detect open lung tuberculosis, so the oral therapy was reduced to double combination with Isoniazid and Rifampicin. Nil Conflict of Interest: The joint space is still maintained in this stage. The late secondary osteoarthritis is always a concern despite the healing of the disease. The management in children as in adults depends upon the stage at presentation.
This consisted of isoniazide, rifampicin, pyrazinamide and pyridoxine. Two children with poor results were seen in this study; they developed fibrous ankylosis.
Jaypee Brothers Tjberculosis Publishers Pvt. Surg Gyne Obstet ; A clinicoradiological classification of tuberculosis of the hip. Open in a separate window. National Center for Biotechnology InformationU.
Tuberculous coxitis: diagnostic problems and varieties of treatment: a case report.
Synovitis stage To establish the diagnosis the patient should be subjected to USG examination; synovial effusion can be aspirated and subjected for cytology, AFB smear and PCR examination. Skeletal tuberculosis in children. He described seven morphological types Figure I based on the destructive pattern for all ages. Hip replacement In tubercular arthritis, as acetabulum is involved, there is no role of hemi replacement. In the stage of synovitis, there is effusion in the joint and the affected limb guberculosis flexed, abducted, and externally rotated with an apparent lengthening of the extremity.
We saw tubercilosis cases in which the prognosis was fair. Table 2 Tubercuoosis classification of tuberculosis of the hip. Phemister, in a detailed pathological study, found that primary bone involvement in children was usually metaphyseal due to embolism and infarction in metaphyseal end arteries. Whenever there is an issue of compliance with continuous traction as in very young children or if joint is very painful, hip spica can be applied for weeks to reduce the pain before movements are started.
In the ‘dislocating’ type, the head dislocates posteriorly, or subluxes due to laxity of ligaments and capsular distension.
Tuberculosis of hip: A current concept review
After surgery, skeletal traction is applied, and movements of the hip are allowed under supervision as soon as patient is able to do.
Finally it should be emphasized, that a decision for performing a less extensive bone-saving operative intervention for the treatment of TBC as a first step with a minimal surgical expenditure for patient and surgeon in a suitable case does not exclude further application of more extensive surgical treatment, thus the above mentioned surgical techniques could be still performed in case of failure. Tectoplasty for painful dislocation or subluxation of the hip.
J Bone Joint Surg ; 44A: The infection can progress through various stages with initial synovitis, effusion and rarefaction, to advanced arthritis with complete destruction. A vigorous passive exercise may produce further pain and spasm and should be avoided. MRI 5 months after starting the oral therapy showing an active arthritis with progressive destruction of the right hip joint and liquid retention in the right acetabulum as a sign of tuberculous osteomyelitis see black arrow.
Furthermore the patient was young and had the compliance for a distinguished rehabilitation. An eight to year followup. Tuberculosis of the hip.
Tuberculosis TB of the hip is second to spine only hence a good number of cases are visiting the medical facilities every year. Thorough debridement of infected tissues and postoperative antituberculous therapy are the keys to lowering the potential risk of reactivation of TB.
The physical load for the right leg was gradually increased and ROM was continuously improved. Katayama R, Itami Y. Early diagnosis can be difficult as the primary clinical symptoms at an early stage tubercklosis well as radiological findings are often non-specific [ 5 ].
Tuberculosis of hip: A current concept review
Log in Sign up. Antitubercular treatment continued postoperatively between 6 coxltis 15 months. An effusion was detected by ultrasound, aspiration of the hip joint led to no further diagnosis as aerobic and anaerobic cultures were sterile. Instead, a stabilization procedure can be done to provide stability.
The reason for our decision to choose a reconstructive bone-saving surgical tberculosis was influenced by different factors. Four cases in this study resembled conditions such as osteochondroma and enchondroma. There is always some residual deformity with late presentation.
In the ‘protrusio-acetabuli’ type, the lesion is mainly in the floor of the acetabulum. There is no sex predilection for the disease.
In the stage of early coxifis, with progressive destruction of the joint, the limb goes into flexion, adduction, and internal rotation, with an apparent limb shortening. Shortening of limb and deformity further complicates the condition. The characteristic radiological manifestations of tuberculosis of the hip were osteopaenia and cystic bone lesions varying in size, resembling chondroblastoma, eosinophilic granuloma and subacute pyogenic osteomyelitis.
Investigations It is suggested that in the endemic regions for TB, a clinical diagnosis supported by radiographs is adequate for starting the treatment. J Bone Joint Surg ;