Tuberculosis Of The Hip


Tuberculosis is still common in India comprising of 27% of world’s cases. A small percentage of TB patients develop bone and joint infections. It is caused by Mycobacteria. Chronic pain, limp, muscle wasting, swelling of the joint, stiffness, and evening fever are common complaints.

X-rays can be normal initially, but can show joint space narrowing, decreased density of the bones, and very little reactive bone formation.  MRI shows bone and joint involvement well. Current standard requires biopsy of the involved tissue to confirm the diagnosis. Cultures of mycobacteria take a long time, but genetic tests of the biopsy specimen give quick results.

The main treatment is nonoperative with multiple drugs and multi drug resistant TB accounts for 27% of cases. TB causes destruction of the articular cartilage, dislocation, protrusio, avascular necrosis, and fibrous ankyloses. Joint debridement, removal of unhealthy tissue can both improve healing and optimize joint function. Pain and stiffness can be treated with arthrodesis, joint excision, or total joint replacement.