Tuberculosis of the Hip joint
Tuberculosis of the hip joint constitutes about 15% of all cases of osteoarticular tuberculosis.
The frequency of involvement is next only to spinal tuberculosis.
Tuberculosis of the hip joint is usually seen in the first three decades of life.
The limp is the earliest and commonest symptom.
Pain is often referred to the inner aspect of the knee and it increases towards the end of the day.
A child may wake from sleep due to night cries.
Antalgic gait with tenderness around the hip and with associated muscle spasm is present.
In 8 to 10% of cases, there will be a palpable cold abscess with or without sinus.
And 10% of cases will have varying degrees of pathological subluxation or dislocation of the hip joint.
Other usual constitutional symptoms like a low-grade fever, lassitude, anorexia, loss of weight, night sweats, tachycardia, and anemia will be present.
There are four stages of tuberculosis of the joint.
Stage I is the stage of synovitis where there is a terminal restriction of movements (>75% of movement are present).
Stage II is the stage of early arthritis where 50 to 75% of movements are preserved.
Stage III is the stage of advanced arthritis with loss of movement > 75% in all directions.
Stage IV is the stage of advanced arthritis with subluxation or dislocation of joints.
Blood investigation like complete blood count, erythrocyte sedimentation rate (ESR), CRP is the basic investigations.
Other investigations are the Mantoux test, synovial fluid analysis, and serological investigation.
The basic radiologic investigation includes pelvis with both hips anteroposterior and frog-leg lateral view followed by higher investigations like ultrasonography, computed tomography, and magnetic resonance imaging.
Biopsy demonstrating the caseation necrosis with tubercle is the diagnostic of tuberculosis of the hip joint.
All patients during the active stage of the disease are treated with multi-drug therapy and traction to correct the deformity and to give rest to the part.
Bilateral traction is mandatory to relieve muscle spasm, to prevent or correct the deformity and subluxation, to maintain the joint space, to minimize the chance of development of migrating acetabulum and permit the close observation of the hip region.
Any palpable cold abscess or joint collections need surgical intervention.
The favourable response is seen in the early stage of disease with appropriate medical and surgical intervention.
In advanced cases, cases treated inappropriately or neglected cases result in unfavourable outcome with deformity and ankylosis of the hip joint.