Scribd Logo
Upload

Welcome to Scribd!

  • 129 views

    Tuberculosis of Hip Joint

    Uploaded by

    Yousra Shaikh
    Tuberculosis of the hip can present in various stages with associated symptoms and clinical findings. It is most common in younger people. Stages range from initial synovitis (Stage I) to advanced arthritis (Stage III) and complications like dislocation (Stage IV). Treatment involves long-term antibiotic therapy along with nutritional and symptomatic support. Additional interventions may include traction, splinting, surgery like synovectomy or corrective osteotomy. The prognosis depends on factors like the virulence of the organism, the host's immunity, and the thoroughness of treatment. With proper management, the outcome can be a mobile and painless hip, though fusion or arthroplasty may sometimes be required in advanced cases.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Tuberculosis of Hip Joint

    Uploaded by

    Yousra Shaikh
    129 views25 pages
    Tuberculosis of the hip can present in various stages with associated symptoms and clinical findings. It is most common in younger people. Stages range from initial synovitis (Stage I) to advanced arthritis (Stage III) and complications like dislocation (Stage IV). Treatment involves long-term antibiotic therapy along with nutritional and symptomatic support. Additional interventions may include traction, splinting, surgery like synovectomy or corrective osteotomy. The prognosis depends on factors like the virulence of the organism, the host's immunity, and the thoroughness of treatment. With proper management, the outcome can be a mobile and painless hip, though fusion or arthroplasty may sometimes be required in advanced cases.

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Tuberculosis of the hip can present in various stages with associated symptoms and clinical findings. It is most common in younger people. Stages range from initial synovitis (Stage I) to advanced arthritis (Stage III) and complications like dislocation (Stage IV). Treatment involves long-term antibiotic therapy along with nutritional and symptomatic support. Additional interventions may include traction, splinting, surgery like synovectomy or corrective osteotomy. The prognosis depends on factors like the virulence of the organism, the host's immunity, and the thoroughness of treatment. With proper management, the outcome can be a mobile and painless hip, though fusion or arthroplasty may sometimes be required in advanced cases.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    129 views25 pages

    Tuberculosis of Hip Joint

    Uploaded by

    Yousra Shaikh
    Tuberculosis of the hip can present in various stages with associated symptoms and clinical findings. It is most common in younger people. Stages range from initial synovitis (Stage I) to advanced arthritis (Stage III) and complications like dislocation (Stage IV). Treatment involves long-term antibiotic therapy along with nutritional and symptomatic support. Additional interventions may include traction, splinting, surgery like synovectomy or corrective osteotomy. The prognosis depends on factors like the virulence of the organism, the host's immunity, and the thoroughness of treatment. With proper management, the outcome can be a mobile and painless hip, though fusion or arthroplasty may sometimes be required in advanced cases.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 25

    TUBERCULOSIS OF HIP

    TUBERCULOUS ARTHRITIS
    OF HIP
    Clinical Presentation
     Common during first 3 decades of life
     General – As in any tuberculosis infection
     Systemic- Depending on primary focus
     Local
     Pain- May be referred to knee
    night cries
    - Limp – Earliest & commonest
    Antalgic Gait
    - Swelling – Fullness around hip
    - Tenderness – Femoral triangle, Gr. Trochanteric (Axial)
    - Muscle Spasm – All around hip & lower abdomen
    Staging
     Stage I (Of synovitis) - D/D of irritable hip
     Joint held in position of maximum capacity

     FABER ( flexion, abduction and external rotation)

     Apparent Lengthening ,no true/real shortening

     Only terminal movements restricted and painful

     Radiological – Soft tissue swelling only

     Ultrasound – may help


    Staging
     Stage II (early arthritis)
    (Stage of apparent shortening)
     Local signs more prominent
     FADIR ( flexion, adduction, internal rotation)
     True shortening ~ 1 cm.
     Muscle wasting appreciable
     Restriction of movements in all direction (25-50%)
     X-ray - Erosion of articular margin
    - Reduced joint space
    - Adjacent osteoporosis
    Staging
     Stage III (Advanced arthritis)
    Deformity, destruction & shortening as
    in II but more marked
    Movement loss > 75%
    o Capsule is destroyed,thickened and
    contracted.
     X-ray – Accentuated findings than II
    Staging
     Stage IV (of complications/ of real shortening)
     Wandering acetabulum
     Protrusio acetabuli
     Mortar & pestle appearance
     Frank post. dislocation of hip
     Clinical & Radiological finding
     Destruction ileofemoral ligament or postural
    prolonged external rotation attitude
     Shenton’s line broken.
     In some cases of aftermath of
    tuberculous arthritis with the
    disease healed in displaced
    position,the femoral head may
    be supported by a buttress
    formed over its posterosuperior
    aspect.
    Other Complication
     Soft tissue complications - Abscesses
    Sinuses
     Bony complication
     Coxa Magna
     Growing stage hyperemia

     Coxa valga with increased anteversion of neck

     Acctabular dysplasia
     Frame Knee
     POP for > 12 Mths.

     Premature fusion of growth plates leads to marked shortening and

    limitation of movements.
     Coxavera – fragmentation and flattening of femoral head (Perthe’s
    type)
    Prognosis
    Virulence of organism Host resistance
    Age, nutritional status, immunity, concomitant other diseases

    Therapeutic intervention
    • At what stage started
    • Response to chemotherapy
    • Supportive conservative,
    mechanical & surgical measures

    Final outcome
    • Mobile painless stable hip
    • Mobile painless unstable hip
    • Fused painless stable hip
    Management
    Investigations
     General – Hb%,TLC,DLC,ESR,PPD

     Specific
     Radiological
     X-ray/ Sinogram
     Ultrasound
     CT Scan/ MRI
     Serological – ELISA, PCR
     Bacteriological
     AFB staining/ Culture & Sensitivity
     Histopathology/ Aspirate examination
     Synovial fluid
     Polymorpho Leukocytosis (10-20,000)
     Decrease sugar
     Increase protein
     Poor mucin clot
     Guinae pig innoculation
    Treatment
    1. ATT – 4 drug (2 cidal)
    Intensive phase for first 3 months)
     Followed by 3 drugs for next 6 months

     Followed by 2 drugs for next 18 months or

    some time 24 months


    2. Nutritional support
    3. Analgesics & muscle relaxants
    4. Judicious use of steroids
    5. Treatment of associated problems
    Treatment
     Mechanical support
     Splints & Plasters
     Traction ( at times bilateral)
     To relieve spasm
     Correct the deformity
     Joint surfaces apart
     Physiotherapy with traction on
    Response to treatment
    4-6 months of conservative treatment

    Favorable response

    Non weight bearing ambulation for 6 months

    With support partial weight bearing for 6 months

    Full weight bearing


    In Advance arthritis
     Usual outcome is Fibrous ankylosis
     Immobilize in ideal position in POP spica for 6
    months
     0-30 degree flexion
     Neutral adduction/ abduction
     5-10 degree external rotation
     Followed by walking in spica for 6 months
     Full weight bearing at 2 yr.
    Special considerations in
    children
     Adductor tenotomy & manipulation under GA
    to correct deformity
     Frame knee- take care
    Arthrodesis of the grossly destroyed hip joint
    or excisional arthroplasty in children should be
    deferred till the completion of growth
    potential.
    Children presenting with the disease healed
    with gross deformity require an extraarticular
    corrective osteotomy.
    Surgical intervention
     Adjuvant to ATT (response to conservative
    treatment unfavourable or outcome
    unacceptable)
     Synovectomy & joint debridement
     Confirms diagnosis, improves circulation & drug delivery
     If done in time, gives useful range of movement without pain
     Along with the hypertrophied synovium,diseased and
    thickened capsule may be excised.
     Can be done without dislocating the hip joint.
     Possible complications are AVN of femoral head,slippage of
    proximal femoral epiphysis in children,fracture of femoral neck
    or acetabulam.
    Corrective osteotomy – Ideal site is as
    near the deformed joint as
    possible(Proximal Femoral)

    Arthrodesis
    Lumbosacral spine,ipsilateral knee and contralateral hip should
    have normal range of motion.
    Done only in patients >18 years of age

    Arthrodesis can be intraarticular or extraarticular or combined

    panarticular.
    In adduction deformity-ischiofemoral,in abduction deformity-

    iliofemoral extraarticular arthrodesis easy to perform.


    Best position 30 degree flexion.np adduction or abduction,5-10

    degree of external rotation .


    Abbott-lucas technique of fusion of hip
    joint in two stages

     Done when there is extensive destruction of head


    and neck of femur,in deficient bone stock.
     When patient prefers strong,fused and painless hip
    joint.
     Can be done in active infections of draining sinuses.
     After removing the femoral neck stump,denuded
    greater trochanter placed into the acetabulum after
    exposing the cancellous bone in 45 degree of
    abduction.
     Second stage-After four to eight weeks osteotomy is
    carried out(5cms below the lesser trochanter)
    Brittain’s technique of extraarticular
    fusion of hip joint
    Upper femoral osteotomy carried out to correct fixed
    deformity of the hip joint
    Free bone graft is used between the osteotomy and a slot
    in the ischium.
    Arthroplasty

     Girdle stone (excisional)


     Leads to mobile unstable hip joint.
     Excision of the femoral head, neck,proximal
    part of trochanter and the acetabular ring.
     Post operatively upper tibial skeletal traction in
    30 to 50 deg abduction for 3 months.
     Active assisted movement of hip and knee
    started during 1st week
     After 3 months non weight bearing walking.
     After 6-9 months walking adviced with the
    stick in contralateral hand.
     Mean loss of length 1.5 cms
     Sometimes leads to very unstable hip
    joint.needs supplementary operations as pelvic
    support osteotomy at the level of ischial
    tuberosity(Milch-Bacheolar type)OR pedicle
    shelf procedure at upper margin of
    acetabulam.
     Interpositional (Amniotic Memb.)

     Total hip replacement


     Atleast after 10 years of last evidence of active
    infection.
     Reactivation recorded in 10-30% of cases.
    Treatment of complication
     Sinuses
     Heal by ATT in 2-3 months
     If not, excision of tract
     Abscesses
     Aspiration & streptomycin/ INH injection
     Evacuation
    Thank You

    You might also like