Dept of Orthopaedics
As old as mankind
India has 80% of all cases
15% - Extra pulmonary
1% - 3% of Extra Pulmonary cases - Skeletal
spine - most common osseous site
hip - 2nd most common osseous site
TB hip : 15% of osteoarticular cases.
primary pulmonary or visceral lymph node foci.
hematogenous spread to hip.
lowered immune response
sites of Hip TB
1st to 3rd decade
tender hip in the active stage
spasm of lower abdominal & adductor
limp/antalgic gait : most common symptom
8% : cold abscess
10% : subluxation or dislocation
if left untreated - progresses through stages of:
Advanced arthritis with subluxation,
dislocation, or ankylosis.
Depends entirely on the stage at
which treatment is initiated.
Synovitis / Early arthritis
normal or near normal hip.
shortening : secondary to dislocation/subluxation, bone destruction,
physis destruction, early fusion of distal
Traction: to correct deformity, decrease spasm,
Cold Abscess: Aspirate & instill Streptomycin +/- INH.
Active & assisted ROM exercises.
(Useful ROM possible, even with more than 50%
of articular surface destroyed)
Unfavorable response to conservative
synovitis: Synovectomy, followed by protected
ambulation after 3 - 6 months.
Later stages: Arthrotomy, synovectomy,
debridement & curettage of cavities.
osteotomy for correction of unacceptable
Pelvic osteotomy to cover the femoral head in
Perthoid type o TB hip.
Total hip replacement.