% - PROGNOSIS , C- CHILDREN , A - adult NORMAL 92% , C - Joint space normal Rx – skin traction , ATT TRAVELLING ACETABULUM – 29% , CA – Lesion in roof of aceta. , decreased joint space .50% C – HIP JOINT DISLOCATED POSt. , destruction of surface and cystic lesion in the acetabulum and head80 % . C – Capital epiphysis fragmented , dense , flattened , neck widened , heals by fibrous ankylosis Protrusio
% - PROGNOSIS , C- CHILDREN , A - adult NORMAL 92% , C - Joint space normal Rx – skin traction , ATT TRAVELLING ACETABULUM – 29% , CA – Lesion in roof of aceta. , decreased joint space .50% C – HIP JOINT DISLOCATED POSt. , destruction of surface and cystic lesion in the acetabulum and head80 % . C – Capital epiphysis fragmented , dense , flattened , neck widened , heals by fibrous ankylosis Protrusio – CA -
Active asisted movements should be started as soon as pain is aubsidedHip mobilzation exercises With traction exercise – sittin , After 4-6 month – ambulation wid crutches , 12 wks – non wt bearing , next 12 wks – partial wt bearing After total 12 mnth – full wt bearing
ADVANTAGES - permits curratge ,to obtain tissue for HPE, exploration of joint , excision of diseased tissue Iliofemoral – easy in ABDUCTION Ishiofemoral – EASY IN ADDUCTION
Indication – extensive femoral head destruction – ABSENCE HEAD, deficient bone stock , Strong , fused , painless hip , BOSWORTH TECH ,.- FEMORO ISCHIAL ARTHRODESIS
Tuberculosis of hip
TUBERCULOSIS OF HIP
DR. HARDIK PAWAR
Oldest disease of human beings
Chronic granulomatous infectious disease
EPTB – 10-15 %
Bone and joint – 1-3 %
Hip joint 2nd most common
Age group – 20 -30 years
Robert Koch discovered
tuberculosis in 1882.
SIZE – 3x0.3 um
Gram positive AFB `
dissemination from primary
Bone & joints TB develop
generally 2-3 yrs after the
1. TB bacilli phagocytosed
by mononuclear cells
2. Epitheloid cell formation
3.Langhans giant cell formed by fusion
epitheliod cells. Formed only if caseation
necrosis has occurred
4.Lymphocytes form a
ring around the lesion
Epitheloid cells-characteristic of TB.
Presence of caseation necrosis almost diagnostic of TB
Caseous exudative type
• more in children
• more destruction
• more exudation
• abscess formation.
Granular proliferative type
• more in adults
• less destructive
• insidious onset/course
• Cellular proliferation
Sites of Hip TB
Acetabular roof - MC
• Insidious onset
• Chronic course
• Commonly associated with constitutional
• Limp or lameness – earliest and commonest
sign , antalgic gait
• Pain - absent in early stage
• Night cries
• Decreased ROM
Fullness around the hip – cold abscess
Deformity - depending on the stage
Wasting of the thigh and gluteal muscle
Limb length discrepency
Due to fixed deformity Secondary chages –
lordosis , scoliosis ,
1. Stage of synovitis :
• Irritable hip , painful movements
• Flexion , abduction , external rotation .
(FABER ) apparent lenghening.
• X-RAY – soft tissue swelling , haziness of
articular margins & rarefaction
• USG – soft tissue swelling
• MRI – synovial effusion
• Biopsy – can be done for confirmation
2. Stage of early arthritis :
Destruction of articular cartilage
Spasm of adductors , flexors + wasting
Flexion , adduction , internal roatation
(FADIR) , Apparent shortening
• ↓sed ROM
• X-RAY – osteopenia , erosion of articular
margins , ↓ joint space
• MRI - synovial effusion , edema , minimal
3. Stage of advanced arthritis :
Further destruction of joint
True shortening > 1 cm
Decrease in ROM
X RAY - further decrease in joint space.
• 4. Advanced arthritis with subluxation /
• Furhter destruction of acetabulum , head ,
capsule and ligaments.
• Gross restriction of ROM
• Head – upwards and posteriorly
• Wandering / migrating acetabulum
• Mortle & pestle appearance
• Reduced joint space
Radiograph showing a ‘travelling’ or
‘wandering’ right hip
Radiograph of the LEFT hip showing the
‘mortar-and-pestle’ type lesion
• ABOTT LUCAS TECHNIQUE :
2 STAGE PROCEDURE
1ST – Arthrodesis in wide abduction
2nd – subtrochantric osteotomy to repostion
• BEST POSITION :
30 DEGREES OF FLEXION
5-10 DEGREES OF ER
HEAD , NECK , RPOXIMAL PART OF TROCHANTER
AND ACETABULAR RIM EXCISED
• EARLY CEMENTLESS THR IN ACTIVE TB
PROVIDED PATIENT IS ADMINISTERED ATT
AND THOROUGH DEBRIDEMENT Of DISEASED
TISSUE IS DONE.
• ( ACCORDING TO RECENT AUTHORS )
- Hardinge et al. 1979
- Kim et al. 1988
• Uncemented - Eskola et al. 1988
- Caparros et al. 1999
- Yoon et al. 2001
Normal hip type tuberculosis lesion of left hip (a, b). Triple chemotherapy for
12 months and bed rest was given. The tuberculosis lesion had healed
without joint damage and sequelae (c)
Perthes type hip
epiphysio-metaphyseal tuberculosis of the left proximal femur (a, b).
After joint debridement, the child was immobilized with cast for 6 weeks under
cover of triple chemotherapy (12 months).
Tuberculosis healed without joint destruction,
though residual coxa magna deformity was present (c)
Atrophic type tuberculosis of hip in
a 11-year-old girl. There is slight joint space narrowing of left hip (a).
After synovectomy chemotherapy for 12 months was given (b, c, d).
Tuberculosis healed (3 years followup) though atrophic head and neck are seen (d)
Campbell JA, Hoffman EB. Tuberculosis of the hip in children.
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2. 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.
3. Moon MS, Kim SS, Lee SR, Moon YW, Moon JL, Moon SI.
Tuberculosis of the hip in children: A retrospective analysis. Ind J
Orthop 2012;46: 91-99.
Eskola A, Santavirta S, Konttinen YT, Tallroth K, Hoikka V,
Lindholm ST. Cementless total replacement for old
tuberculosis of the hip. J Bone Joint Surg (Br) 1988;70:603–
Yoon TR, Rowe SM, Santosa SB, Jung ST, Seon JK.
Immediate cementless total hip arthroplasty for the
treatment of active tuberculosis. J Arthroplasty. 2005;20:923–
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