TB Hip
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TB Hip

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TB Hip TB Hip Presentation Transcript

  • Tuberculosis Hip Dr.Sarthy.V DNB Dept of Orthopaedics
  • TUBERCULOSIS As old as mankind India has 80% of all cases 15% - Extra pulmonary 1% - 3% of Extra Pulmonary cases - Skeletal (osteoarticular) TB. spine - most common osseous site hip - 2nd most common osseous site TB hip : 15% of osteoarticular cases.
  • Pathogenesis primary pulmonary or visceral lymph node foci. hematogenous spread to hip. Precipitating factors: poor nutrition lowered immune response
  • sites of Hip TB acetabular roof epiphysis greater trochanter neck/metaphysis
  • Disease course osteomyelitis osteoarticular rapid destruction cold abscess tracks to femoral triangle,thigh, ischiorectal fossa, pelvis.
  • clinical features 1st to 3rd decade pain limp stiffness deformity night cry tender hip in the active stage spasm of lower abdominal & adductor muscles.
  • limp/antalgic gait : most common symptom 8% : cold abscess 10% : subluxation or dislocation if left untreated - progresses through stages of: Synovitis Early arthritis Late arthritis Advanced arthritis with subluxation, dislocation, or ankylosis.
  • TKS Radiological classification Text Text
  • Prognosis Depends entirely on the stage at which treatment is initiated.
  • Early disease: Synovitis / Early arthritis normal or near normal hip.
  • Advanced arthritis fibrous ankylosis. shortening : secondary to dislocation/subluxation, bone destruction, physis destruction, early fusion of distal femoral physis.
  • Management ACTIVE STAGE ATT Traction: to correct deformity, decrease spasm, decrease pain. Cold Abscess: Aspirate & instill Streptomycin +/- INH. RESOLVING Active & assisted ROM exercises. (Useful ROM possible, even with more than 50% of articular surface destroyed)
  • Surgery Unfavorable response to conservative management. synovitis: Synovectomy, followed by protected ambulation after 3 - 6 months. Later stages: Arthrotomy, synovectomy, debridement & curettage of cavities.
  • osteotomy for correction of unacceptable ankylosis. Pelvic osteotomy to cover the femoral head in Perthoid type o TB hip. Arthrodesis. Excision arthroplasty. Total hip replacement.
  • Arthrotomy, synovectomy, debridement & curettage of cavities.
  • Osteotomy & Arthrodesis
  • Pelvic Osteotomy
  • Arthrodesis
  • Excision Arthroplasty
  • Arthroplasty
  • THANK YOU