Abstract
Background: Tuberculosis (TB) of hip constitutes nearly 15% of all cases of osteoarticular tuberculosis. We report a retrospective study carried out on 43 children with hip TB.
Materials and Methods: Forty-three children of TB hip treated between 1971 and 2000 were analysed. Twenty-four children of the early series were treated with streptomycin (S), isoniazid (H) and PAS (Pa) for 18 months (3HPaS, 15 HPa), while 19 children in the later series were treated with isoniazid (H), rifampicin (R) and ethambutol (E) or pyrazinamide (Z) for 12 months [(12 RHE(Z)]. Five out of 18 children with radiologically normal appearing type hip TB were treated with chemotherapy alone and 38 children were subjected to surgery; simple synovectomy alone in 31 hips, joint debridement in six hips, and proximal femoral varisation osteotomy in one. After surgery hips were immobilized in cast for one to three months according to the severity of the disease and patients pain tolerance, and then were mobilized under leg traction in bed gradually till pain subsided completely.
Results: TB of hip healed with minimum sequelae in all children. In 18 Type one hip TB, normal hip (synovial form) anatomy was maintained, and in 25 patients with advanced lesions some defect in the femoral head and acetabulum was noticed, though painless good hip motion was maintained. Excellent to good results were obtained in 31 children (73.1%), fair in eight (18.6%), and poor in four (9.3%). In four patients with poor results, there was some residual morphological defect in the hip. None developed ankylosis of hip.
Conclusion: We achieved good outcome with minimum sequelae in this series. The management goal should be aimed not only to heal the disease but also to maintain a painless mobile hip and anatomical cephalocotyloid relationship until maturity, and retard the development of secondary osteoarthritis.
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References
Babhulkar S, Pande S. Tuberculosis of the hip. Clin Orthop Relat Res 2002;398:93–9.
Campbell JA, Hoffman EB. Tuberculosis of the hip in children. J Bone Joint Surg Br 1995;77:319–26.
Shanmugasundaram TK. A clinicoradiological classification of tuberculosis of the hip. In: Shanmugasundaram TK (editor). Current concepts in bone and joint tuberculosis. Madras, India: Proceedings of Combined Congress of International Bone and Joint Tuberculosis Club and the Indian Orthop Assoc;1983. P. 60.
Vora PH. Role of early surgery in management of tuberculosis of hip. In: Shanmugasundaram TK (Editor). Current concept in bone and joint tuberculosis. Madras, India: Proceedings of Combined Congress of International Bone and Joint Tuberculosis Clue and the Indian Orthopedic Association;1983.p. 60.
Metha MT. Prognosis of tuberculous arthritis. In: Shanmugasundaram TK (Editor) ibi-dem 1983, Chennai., p. 78–80.
Masood S. Diagnosis of tuberculosis of bone and soft tissue by fine needle aspiration biopsy. Diagn Cytopathol 1992;8:451–4.
Tuli SM. Tuberculosis of the hip joint. Tuberculosis of the skeletal system (Bones, Joints, Spine and Bursal sheaths). 2nd ed. New Delhi: Jaypee Brothers Medical Publishers PVT Ltd; 1997. p.59–96.
Mousa HA. Evaluation of sinus-tract cultures in chronic bone infection. J Bone Joint Surg 1997;78:567–9.
Finegold SM, Baron EJ. Baily and Scott’s diagnostic microbiology. St Louis: Mosby Co;1986.
Moon MS, Kim I, Jung TI. Diagnosis of bone lesion by fine needle aspiration biopsy. J Korea Orthop Assoc 1978;13:7–12.
Moon MS, Kim I, Kim JM, Lee HS, Ahn YP. Synovial biopsy by Franklin-Silverman needle. Clin Orthop Relat Res 1980;150:224–8.
Moon MS, Rhee SK, Lee KS, Kim SS. A natural course of a dislocated healed tuberculous hip in a child: A case report. Clin Orthop Relat Res 1984;190:154–7.
Moon MS, Lee KS, Kim YS. Varisation osteotomy in subluxated hip as sequella of healed tuberculosis in children. J Korea Orthop Assoc 1982;17:203–5.
Moon MS, Choi NY. Treatment of residual dislocation and subluxation of tuberculous hip in children. In: Ueno, Akamatsu, Itami, editors. The Hip Clinical studies and basic research. Amsterdam; New York; Tokyo: Excerpta Medica, Internet Series; 1984. p. 634.
Mitchell GP. Management of acquired dislocation of the hip in septic arthritis. Orthop Clin North Am 1980;11:51–64.
Medical Research Council Working Party on Tuberculosis of Spine: Five-year assessment of controlled trials of ambulant treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Rhodesia and Hong Kong. J Bone Joint Surg 1978;60:163–76.
Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequellae and reconstruction after septic arthritis of hip in infants. J Bone Joint Surg Am 1990;72:1150–65.
Somerville EG. Displacement of the hip in children. Aetiology, management and sequellae. Berlin, Heidleberg: Springer-Verlag; 1982.p.104–6.
Moon MS, Sun DH, Jung CH. Surgical treatment of pathological dislocation of child hip after acute osteomyelitis of ilium - a case report. J Korea Orthop Assoc 1994;29:412–14.
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Moon, MS., Kim, SS., Lee, SR. et al. Tuberculosis of hip in children: A retrospective analysis. IJOO 46, 191–199 (2012). https://doi.org/10.4103/0019-5413.93686
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DOI: https://doi.org/10.4103/0019-5413.93686